Provider Demographics
NPI:1124597992
Name:BEARTH PEACE PREMIER DOULA SERVICES, LLC
Entity Type:Organization
Organization Name:BEARTH PEACE PREMIER DOULA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FULL SPECTRUM DOULA
Authorized Official - Prefix:MS
Authorized Official - First Name:DEWANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-532-0280
Mailing Address - Street 1:41 HACKENSACK ST APT 1
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1413
Mailing Address - Country:US
Mailing Address - Phone:678-532-0280
Mailing Address - Fax:
Practice Address - Street 1:41 HACKENSACK ST APT 1
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1413
Practice Address - Country:US
Practice Address - Phone:678-532-0280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty