Provider Demographics
NPI:1861752776
Name:BREATH OF LIFE PROFESSIONAL SERVICES, NFP, INC.
Entity type:Organization
Organization Name:BREATH OF LIFE PROFESSIONAL SERVICES, NFP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUIVE DIIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:PRATO
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:630-570-5299
Mailing Address - Street 1:2725 35TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2612
Mailing Address - Country:US
Mailing Address - Phone:630-570-5299
Mailing Address - Fax:630-570-5298
Practice Address - Street 1:2725 35TH ST
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2612
Practice Address - Country:US
Practice Address - Phone:630-570-5299
Practice Address - Fax:630-570-5298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health