BREATH OF LIFE WELLNESS CENTER (NPI# 1972780690) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972780690 |
| Entity Type | Organization |
| Organization Name | BREATH OF LIFE WELLNESS CENTER |
| Practice Address |
2021 S Waverly Ave Suite 500 Springfield MO 65804-2414 |
| Mailing Address |
2021 S. Waverly Suite 500 Springfield MO 65804 |
| Practice Telephone | 4178831141 |
| Practice Fax Number | 4178896627 |
| Mailing Telephone | 4178831141 |
| Mailing Fax Number | 4178896627 |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2008-01-24 |
| Authorized Official Name | NICOLE MCCAULEY (OWNER) |
| Authorized Official Telephone | 4178831141 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251300000X | Local Education Agency (LEA) | 2005007366 | MO | Agencies |
| Street Address |
2021 S WAVERLY AVE SUITE 500 |
| City | SPRINGFIELD |
| State | MO |
| Zip Code | 65804-2414 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225018484 | Paul William Iles Jr. | Psychologist | 2021 S Waverly Ave, Suite 700, Springfield, MO 65804-2414 | 2006-01-21 |
| 1821353285 | James Nc Peterson | Chiropractor | 2021 S Waverly Ave, Suite 500, Springfield, MO 65804-2414 | 2012-07-11 |
| 1053629386 | Crystal Joifrita | Counselor | 2021 S Waverly Ave, Suite 500, Springfield, MO 65804-2414 | 2010-09-21 |
| 1134380306 | Aaron Duane Calloway | Counselor | 2021 S Waverly Ave, Ste. 700, Springfield, MO 65804-2414 | 2008-06-20 |
| 1043471386 | Michael Andrew Boccasini | Counselor | 2021 S Waverly Ave, Suite 700, Springfield, MO 65804-2414 | 2008-06-19 |
| 1093908691 | Carrie E Thomas | Social Worker | 2021 S Waverly Ave, Ste 700, Springfield, MO 65804-2400 | 2007-08-27 |
| 1922141670 | Gloria E. Mire | Counselor | 2021 S Waverly Ave, Suite 500, Springfield, MO 65804-2414 | 2007-02-14 |
| 1487718326 | Life Development Counselors | Counselor | 2021 S Waverly Ave, Suite 500, Springfield, MO 65804-2414 | 2006-12-21 |
| 1326109984 | Kathryn Boone | Counselor | 2021 S Waverly Ave, Suite 500, Springfield, MO 65804-2414 | 2006-12-13 |
| 1760462923 | Katherine Morrow Tynes | Social Worker | 2021 S Waverly Ave, Suite 700, Springfield, MO 65804 | 2006-01-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790393049 | Kathy Forson | Nurse Practitioner | 1235 E. Cherokee St., Springfield, MO 65804 | 2020-07-22 |
| 1306498779 | Anne B Summers, LLC | Social Worker | 1310 E. Kingsley St., Ste C, Springfield, MO 65804 | 2019-07-15 |
| 1790241800 | Margaret Mary Hart | Social Worker | 1845 S Rogers Ave, Springfield, MO 65804 | 2019-02-13 |
| 1598254666 | Casey Carr | Optometrist | 1229 E Seminole St Ste 110, Springfield, MO 65804 | 2018-05-04 |
| 1124520697 | Shelby D White | Behavioral Analyst | 1300 E. Bradford Parkway, Springfield, MO 65804 | 2018-03-01 |
| 1316448343 | Karl Lynham | Massage Therapist | 1200 E Woodhurst Dr R300, Springfield, MO 65804 | 2018-02-25 |
| 1699273763 | Leah Wilson | Counselor | 1322 E Woodgate, Springfield, MO 65804 | 2018-01-24 |
| 1295242626 | Matthew Crisp | Physical Therapist | 3252 E Independence St, Springfield, MO 65804 | 2018-01-08 |
| 1518491042 | Crystal Spangler | Dietitian, Registered | 1965 S Fremont Ave Ste 220, Springfield, MO 65804 | 2017-04-11 |
| 1588012033 | Jeffrey Williams | Pharmacist | 1235 E. Cherokee, Springfield, MO 65804 | 2016-05-25 |
| Find all providers in zip 65804 | ||||
| Taxonomy Code | 251300000X |
| Grouping | Agencies |
| Classification | Local Education Agency (LEA) |
| The term local education agency means a public board of education or other public authority legally constituted within a State to either provide administrative control or direction of, or perform a service function for public schools serving individuals ages 0 - 21 in a state, city, county, township, school district, or other political subdivision including a combination of school districts or counties recognized in a State as an administrative agency for its public schools. An LEA may provide, or employ professional who provide, services to children included in the Individuals with Disabilities Education Act (IDEA), such services may include, but are not limited to, such medical services as physical, occupational, and speech therapy. |
| Notes: Source: Portions of IDEA Regulations Part B (34 CFR Part 300.18, Assistance to States for the Education of Children with Disabilities) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538642467 | Lane County School District No. 19 | Local Education Agency (LEA) | 640 A St, Springfield, OR 97477-4609 | 2018-09-06 |
| 1811362031 | Baystate Academy Charter Public School | Local Education Agency (LEA) | 2001 Roosevelt Ave, Springfield, MA 01104-1657 | 2015-12-14 |
| 1649556671 | Springfield Preparatory & Fitness Academy | Local Education Agency (LEA) | 1615 Selma Rd, Springfield, OH 45505-4245 | 2011-10-21 |
| 1295972016 | Springfield Academy of Excellence | Local Education Agency (LEA) | 623 S Center St, Springfield, OH 45506-2209 | 2009-01-15 |
| 1932345980 | Northeastern Local Schools | Local Education Agency (LEA) | 1414 Bowman Rd, Springfield, OH 45502-8826 | 2008-12-22 |
| 1184869554 | Northwestern Local School District | Local Education Agency (LEA) | 5610 Troy Rd, Springfield, OH 45502-9032 | 2008-12-12 |
| 1235374760 | Clark-shawnee Local Schools | Local Education Agency (LEA) | 3680 Selma Rd, Springfield, OH 45502-6310 | 2008-12-12 |
| 1073771127 | Rivendale | Local Education Agency (LEA) | 1613 W Elfindale St, Springfield, MO 65806-1287 | 2008-05-27 |
| 1750562690 | Washington County Schools | Local Education Agency (LEA) | 120 Mackville Hl, Springfield, KY 40069-1013 | 2007-11-20 |
| 1508077942 | Northern Educational Service Inc. | Local Education Agency (LEA) | 736 State St, Springfield, MA 01109-4110 | 2007-05-25 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 65804 |
Please comment or provide details below to improve the information on BREATH OF LIFE WELLNESS CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.