Organization
BREATH OF LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERNADETTE COOPER (SUPPORTED LIVING ARRANGEMENT PROV.)
(775) 626-5880
Entity
Organization
Contact information
Practice address
4944 DIANA CT, SPARKS, NV 89436-8634
(775) 354-0707
(775) 626-5880
Mailing address
1542 IRATCABAL DR, SPARKS, NV 89436-8637
(775) 354-0707
(775) 626-5880
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
NV20111404144
NV
385H00000X
Respite Care
Primary
—
—
Other
Enumeration date
05/03/2016
Last updated
10/17/2019
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