Provider Demographics
NPI:1073057089
Name:BAYSIDE BIRTH
Entity Type:Organization
Organization Name:BAYSIDE BIRTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-321-1560
Mailing Address - Street 1:2401 RUCKER AVE
Mailing Address - Street 2:APT 8
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2791
Mailing Address - Country:US
Mailing Address - Phone:859-321-1560
Mailing Address - Fax:
Practice Address - Street 1:2401 RUCKER AVE
Practice Address - Street 2:APT 8
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2791
Practice Address - Country:US
Practice Address - Phone:859-321-1560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty