Provider Demographics
NPI:1447879630
Name:MOONRISE WELLNESS & BIRTH CENTER
Entity type:Organization
Organization Name:MOONRISE WELLNESS & BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LM
Authorized Official - Phone:206-930-6027
Mailing Address - Street 1:5720 220TH ST SW STE A
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-3137
Mailing Address - Country:US
Mailing Address - Phone:206-930-6027
Mailing Address - Fax:
Practice Address - Street 1:5720 220TH ST SW STE A
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-3137
Practice Address - Country:US
Practice Address - Phone:206-930-6027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health