Provider Demographics
NPI:1447642046
Name:THE CENTER FOR BIRTH, LLC
Entity type:Organization
Organization Name:THE CENTER FOR BIRTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE (CDM)
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-357-7781
Mailing Address - Street 1:780 S SNODGRASS DR
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-9149
Mailing Address - Country:US
Mailing Address - Phone:907-357-7781
Mailing Address - Fax:907-357-7786
Practice Address - Street 1:780 S SNODGRASS DR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9149
Practice Address - Country:US
Practice Address - Phone:907-357-7781
Practice Address - Fax:907-357-7786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKFBC-016261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1016699Medicaid