Provider Demographics
NPI:1437926029
Name:GRACE BIRTH AND WELLNESS
Entity Type:Organization
Organization Name:GRACE BIRTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE, DOULA, LIFE COACH
Authorized Official - Prefix:
Authorized Official - First Name:TERRESA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:CPM/DOULA
Authorized Official - Phone:150-368-6909
Mailing Address - Street 1:18470 SW BOONES FERRY RD APT L206
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7092
Mailing Address - Country:US
Mailing Address - Phone:036-869-0995
Mailing Address - Fax:
Practice Address - Street 1:18470 SW BOONES FERRY RD APT L206
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7092
Practice Address - Country:US
Practice Address - Phone:036-869-0995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing