Provider Demographics
NPI:1114393220
Name:THE BIRTH PLACE, LLC
Entity Type:Organization
Organization Name:THE BIRTH PLACE, LLC
Other - Org Name:THE BIRTH SWEET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNDIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:435-656-2000
Mailing Address - Street 1:375 E TABERNACLE ST
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2939
Mailing Address - Country:US
Mailing Address - Phone:435-656-2000
Mailing Address - Fax:435-767-0767
Practice Address - Street 1:2333 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-5635
Practice Address - Country:US
Practice Address - Phone:435-817-7696
Practice Address - Fax:435-767-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing