Provider Demographics
NPI:1609473826
Name:SACRED BIRTH LLC
Entity Type:Organization
Organization Name:SACRED BIRTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-331-7430
Mailing Address - Street 1:754 E COLE ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-8953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:860 RIVER DR
Practice Address - Street 2:
Practice Address - City:GUERNSEY
Practice Address - State:WY
Practice Address - Zip Code:82201
Practice Address - Country:US
Practice Address - Phone:307-331-7430
Practice Address - Fax:307-939-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing