Provider Demographics
NPI:1780180901
Name:BABYMOON INN FAMILY CARE LLC
Entity Type:Organization
Organization Name:BABYMOON INN FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:602-314-7755
Mailing Address - Street 1:21001 N TATUM BLVD STE 1630-215
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4242
Mailing Address - Country:US
Mailing Address - Phone:602-314-7755
Mailing Address - Fax:602-314-7756
Practice Address - Street 1:202 E MORRIS DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2323
Practice Address - Country:US
Practice Address - Phone:602-314-7755
Practice Address - Fax:602-314-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty