| Breath Of Life Incorporated | |
|
625 S Diamond St Centralia WA 98531-3817 | |
| (360) 807-8476 | |
| Not Available |
| Full Name | Breath Of Life Incorporated |
|---|---|
| Speciality | Counselor |
| Location | 625 S Diamond St, Centralia, Washington |
| Authorized Official Name and Position | Sherri Lynn Coult Hamilton (PRESIDENT) |
| Authorized Official Contact | 3608801961 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Breath Of Life Incorporated Po Box 1241 Centralia WA 98531-0730 Ph: (360) 807-8476 | Breath Of Life Incorporated 625 S Diamond St Centralia WA 98531-3817 Ph: (360) 807-8476 |
| NPI Number | 1538802707 |
|---|---|
| Provider Enumeration Date | 04/15/2022 |
| Last Update Date | 03/27/2024 |
| Certification Date | 03/19/2024 |
| Medicare PECOS PAC ID | 4789021361 |
|---|---|
| Medicare Enrollment ID | O20240318003747 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538802707 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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