Provider Demographics
NPI:1528575321
Name:GREAT EXPECTATIONS BIRTH
Entity Type:Organization
Organization Name:GREAT EXPECTATIONS BIRTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POKLUDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-223-0226
Mailing Address - Street 1:330 BUTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2257
Mailing Address - Country:US
Mailing Address - Phone:214-223-0226
Mailing Address - Fax:
Practice Address - Street 1:4811 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4694
Practice Address - Country:US
Practice Address - Phone:214-223-0226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty