Provider Demographics
NPI:1821593187
Name:MAIDEN TO MOTHER MIDWIFERY, LLC
Entity Type:Organization
Organization Name:MAIDEN TO MOTHER MIDWIFERY, LLC
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, CPM
Authorized Official - Phone:954-404-3502
Mailing Address - Street 1:4431 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-1531
Mailing Address - Country:US
Mailing Address - Phone:954-404-3502
Mailing Address - Fax:954-337-2480
Practice Address - Street 1:4431 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-1531
Practice Address - Country:US
Practice Address - Phone:954-404-3502
Practice Address - Fax:561-560-8852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW283176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009785100Medicaid