Provider Demographics
NPI:1376071332
Name:ASSIST IN A MIRACLE, LLC
Entity Type:Organization
Organization Name:ASSIST IN A MIRACLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:AMARYLLIS
Authorized Official - Last Name:OGLE
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:425-971-3731
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-0212
Mailing Address - Country:US
Mailing Address - Phone:425-971-3731
Mailing Address - Fax:
Practice Address - Street 1:7149 MAXWELTON RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-8813
Practice Address - Country:US
Practice Address - Phone:425-971-3731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60452672176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty