Provider Demographics
NPI:1659763431
Name:THE BIRTH NEST AT CATLIN COURT
Entity Type:Organization
Organization Name:THE BIRTH NEST AT CATLIN COURT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GALEN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-606-7347
Mailing Address - Street 1:5622 W PALMAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-2510
Mailing Address - Country:US
Mailing Address - Phone:623-606-7347
Mailing Address - Fax:602-926-0999
Practice Address - Street 1:5622 W PALMAIRE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2510
Practice Address - Country:US
Practice Address - Phone:623-606-7347
Practice Address - Fax:602-926-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing