Provider Demographics
NPI:1891161188
Name:GENTLE HARBOR MIDWIFERY
Entity Type:Organization
Organization Name:GENTLE HARBOR MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:269-470-2611
Mailing Address - Street 1:1793 NEWMAN TER
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-6532
Mailing Address - Country:US
Mailing Address - Phone:269-470-2611
Mailing Address - Fax:
Practice Address - Street 1:1793 NEWMAN TER
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-6532
Practice Address - Country:US
Practice Address - Phone:269-470-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TERRIE LEMLEY, CNM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QB0400X, 261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical