Provider Demographics
NPI:1861604811
Name:BREATH OF LIFE RESEARCH INSTITUTE INC.
Entity type:Organization
Organization Name:BREATH OF LIFE RESEARCH INSTITUTE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:281-398-7353
Mailing Address - Street 1:PO BOX 197
Mailing Address - Street 2:
Mailing Address - City:BARKER
Mailing Address - State:TX
Mailing Address - Zip Code:77413-0197
Mailing Address - Country:US
Mailing Address - Phone:281-398-7353
Mailing Address - Fax:281-398-7357
Practice Address - Street 1:21715 KINGSLAND BLVD
Practice Address - Street 2:SUITE # 103
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2543
Practice Address - Country:US
Practice Address - Phone:281-398-7353
Practice Address - Fax:281-398-7357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care