Provider Demographics
NPI:1871092627
Name:KANGAROO BIRTHING & MATERNITY CONCIERGE LLC
Entity type:Organization
Organization Name:KANGAROO BIRTHING & MATERNITY CONCIERGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DOULA/MATERNITY COACH
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYREETA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-377-4051
Mailing Address - Street 1:2907 SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-2556
Mailing Address - Country:US
Mailing Address - Phone:412-377-4051
Mailing Address - Fax:
Practice Address - Street 1:2907 SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-2556
Practice Address - Country:US
Practice Address - Phone:412-377-4051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA374J00000XMedicaid