Provider Demographics
NPI:1629465885
Name:ABUNDANT LIFE BIRTH CENTER, LLC
Entity Type:Organization
Organization Name:ABUNDANT LIFE BIRTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEFFENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:772-200-4277
Mailing Address - Street 1:611 SW FEDERAL HWY STE M
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2925
Mailing Address - Country:US
Mailing Address - Phone:772-200-4277
Mailing Address - Fax:772-919-4280
Practice Address - Street 1:611 SW FEDERAL HWY STE M
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2925
Practice Address - Country:US
Practice Address - Phone:772-200-4277
Practice Address - Fax:772-919-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing