Provider Demographics
NPI:1275828204
Name:YOUR HOME BIRTH LLC
Entity Type:Organization
Organization Name:YOUR HOME BIRTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:PAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPM
Authorized Official - Phone:616-295-1128
Mailing Address - Street 1:120 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1206
Mailing Address - Country:US
Mailing Address - Phone:616-295-1128
Mailing Address - Fax:
Practice Address - Street 1:120 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1206
Practice Address - Country:US
Practice Address - Phone:616-295-1128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty