Provider Demographics
NPI:1558944546
Name:THE BIRTH TRIBE LLC
Entity Type:Organization
Organization Name:THE BIRTH TRIBE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURR
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:914-299-7171
Mailing Address - Street 1:17 PINE GROVE DR SIDE A
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7098
Mailing Address - Country:US
Mailing Address - Phone:914-299-7171
Mailing Address - Fax:386-204-7117
Practice Address - Street 1:800 S NOVA RD STE R
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-7362
Practice Address - Country:US
Practice Address - Phone:386-227-7663
Practice Address - Fax:386-204-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101854800Medicaid