Provider Demographics
NPI:1073144465
Name:BABYMOON INN OF TUCSON, LLC
Entity Type:Organization
Organization Name:BABYMOON INN OF TUCSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:RYERSON
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-314-7755
Mailing Address - Street 1:21001 N TATUM BLVD STE 1630-215
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4242
Mailing Address - Country:US
Mailing Address - Phone:602-314-7755
Mailing Address - Fax:602-314-7756
Practice Address - Street 1:3337 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1349
Practice Address - Country:US
Practice Address - Phone:520-827-8150
Practice Address - Fax:520-827-8150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BABYMOON INN OF TUCSON, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing