Provider Demographics
NPI:1821531435
Name:LEGACY BIRTH, LLC
Entity Type:Organization
Organization Name:LEGACY BIRTH, LLC
Other - Org Name:LEGACY BIRTH
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALEM
Authorized Official - Middle Name:REJOICE
Authorized Official - Last Name:SILVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:806-513-9980
Mailing Address - Street 1:2401 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3413
Mailing Address - Country:US
Mailing Address - Phone:806-513-9980
Mailing Address - Fax:806-412-5575
Practice Address - Street 1:2401 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3413
Practice Address - Country:US
Practice Address - Phone:806-513-9980
Practice Address - Fax:806-412-5575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99276176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty