Provider Demographics
NPI:1073228367
Name:THAT'S MY DOULA LLC
Entity Type:Organization
Organization Name:THAT'S MY DOULA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SALA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-974-0518
Mailing Address - Street 1:2175 NORFOLK APT 101
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3194
Mailing Address - Country:US
Mailing Address - Phone:313-974-0518
Mailing Address - Fax:
Practice Address - Street 1:2175 NORFOLK APT 101
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3194
Practice Address - Country:US
Practice Address - Phone:313-974-0518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS530758012197Medicaid