Organization Active NPI

Breath of Life Mental Health and Wellness

  • Psychiatric/Mental Health Nurse Practitioner
  • Greenville, NC
National Provider Identifier
1912716739
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
BREATH OF LIFE MENTAL HEALTH AND WELLNESS
Practice address
710 Cromwell Dr Ste F
Greenville, NC 27858-5441
Phone
(252) 651-3325
NPI assigned
Jan 6, 2025
Last updated
Jul 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Judgette Green, NPNPI 1689448409
Title
Owner
Phone
(252) 651-3325

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

710 Cromwell Dr Ste F
Greenville, NC 27858-5441

Mailing address

710 Cromwell Dr Ste F
Greenville, NC 27858-5441
Phone (252) 651-3325

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250423000263 NC Part B Supplier - Clinic/Group Practice 9335664325 Receives reassigned benefits from 1 practitioner
Practice locations: Greenville, NC

National Provider Directory

National Provider Directory

Locations

710 Cromwell Dr
Ste F
Greenville, NC 27858
Phone (252) 651-3325

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753228800000",
    "number": "1912716739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 CROMWELL DR STE F",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278585441",
            "telephone_number": "252-651-3325",
            "fax_number": "252-253-6554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 CROMWELL DR STE F",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278585441",
            "telephone_number": "252-651-3325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREATH OF LIFE MENTAL HEALTH AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-06",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JUDGETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-651-3325",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.