Provider Demographics
NPI:1710405691
Name:PALMS BIRTH HOUSE
Entity Type:Organization
Organization Name:PALMS BIRTH HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARRON
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:561-455-2703
Mailing Address - Street 1:236 SE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7620
Mailing Address - Country:US
Mailing Address - Phone:561-455-2703
Mailing Address - Fax:561-952-0856
Practice Address - Street 1:236 SE 23RD AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7620
Practice Address - Country:US
Practice Address - Phone:561-455-2703
Practice Address - Fax:561-560-8852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL341261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006453500Medicaid