Provider Demographics
NPI:1750858403
Name:VITALITY GENERATION & MIDWIFERY, LLC
Entity Type:Organization
Organization Name:VITALITY GENERATION & MIDWIFERY, LLC
Other - Org Name:MY FAMILY BIRTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHUPE
Authorized Official - Suffix:
Authorized Official - Credentials:CPM
Authorized Official - Phone:801-628-4573
Mailing Address - Street 1:431 E 2700 N
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414
Mailing Address - Country:US
Mailing Address - Phone:801-628-4573
Mailing Address - Fax:801-436-5182
Practice Address - Street 1:5319 S 500 E
Practice Address - Street 2:STE C
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-917-6104
Practice Address - Fax:801-436-5182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty