Provider Demographics
NPI:1922438431
Name:BIRTH BLOSSOMS LLC
Entity Type:Organization
Organization Name:BIRTH BLOSSOMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:RAINER
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:772-475-8560
Mailing Address - Street 1:1903 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-8101
Mailing Address - Country:US
Mailing Address - Phone:772-475-8560
Mailing Address - Fax:772-801-5293
Practice Address - Street 1:1903 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-8101
Practice Address - Country:US
Practice Address - Phone:772-475-8560
Practice Address - Fax:772-801-5293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW264176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0006593100Medicaid