Provider Demographics
NPI:1114783941
Name:TRI CITY BIRTH COLLECTIVE LLC
Entity Type:Organization
Organization Name:TRI CITY BIRTH COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CERTIFIED DOULA
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:EVA MARRIE
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:CD(DONA), LCCE
Authorized Official - Phone:989-820-2817
Mailing Address - Street 1:4900 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-3232
Mailing Address - Country:US
Mailing Address - Phone:989-820-2817
Mailing Address - Fax:
Practice Address - Street 1:4900 BELMONT ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-3232
Practice Address - Country:US
Practice Address - Phone:989-820-2817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1346951381Medicaid