Provider Demographics
NPI:1144720061
Name:BREATH OF LIFE HEALTH CARE PLLC
Entity type:Organization
Organization Name:BREATH OF LIFE HEALTH CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY ALICE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-758-9699
Mailing Address - Street 1:8607 W DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-9603
Mailing Address - Country:US
Mailing Address - Phone:208-699-7644
Mailing Address - Fax:
Practice Address - Street 1:750 N SYRINGA ST STE 201B
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5275
Practice Address - Country:US
Practice Address - Phone:208-758-9699
Practice Address - Fax:208-758-8535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QS1201X
IDM6380207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty