Provider Demographics
NPI:1205182961
Name:HOME4BIRTH LLC
Entity Type:Organization
Organization Name:HOME4BIRTH LLC
Other - Org Name:HOME4BIRTH
Other - Org Type:Other Name
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRAHAM-WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, CDEM
Authorized Official - Phone:765-643-9433
Mailing Address - Street 1:12840 FORD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2894
Mailing Address - Country:US
Mailing Address - Phone:765-643-9433
Mailing Address - Fax:765-250-9389
Practice Address - Street 1:12987 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-3864
Practice Address - Country:US
Practice Address - Phone:765-643-9433
Practice Address - Fax:317-355-6029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN72000118A176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty