| Organization Name: | BREATH OF LIFE ASTHMA CLINIC |
| NPI Number: | 1174997548 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DARNELL INGRAM (C.E.O. / RESPIRATORY THERAPIST) |
| Mailing Address: | 17331 Wooded Path Dr East Hazel Crest |
| State: | IL US |
| Postal Code: | 604291961 |
| Phone Number: | 3127094898 |
| Fax Number: | |
| NPI Enumeration Date: | 11/22/2015 |
| NPI Last Update Date: | 11/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |