Provider Demographics
NPI:1518086800
Name:GREENBANK WOMEN'S CLINIC AND BIRTH CENTER, LIMITED
Entity Type:Organization
Organization Name:GREENBANK WOMEN'S CLINIC AND BIRTH CENTER, LIMITED
Other - Org Name:GREENBANK BIRTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED MIDWIFE
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:360-678-3594
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:GREENBANK
Mailing Address - State:WA
Mailing Address - Zip Code:98253-0067
Mailing Address - Country:US
Mailing Address - Phone:360-678-3594
Mailing Address - Fax:360-678-3783
Practice Address - Street 1:3455 OLD COUNTY ROAD
Practice Address - Street 2:
Practice Address - City:GREENBANK
Practice Address - State:WA
Practice Address - Zip Code:98253-0067
Practice Address - Country:US
Practice Address - Phone:360-678-3594
Practice Address - Fax:360-678-3594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACBC-013261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing