Provider Demographics
NPI:1922879634
Name:UNEARTHED BIRTH LLC
Entity Type:Organization
Organization Name:UNEARTHED BIRTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-821-7912
Mailing Address - Street 1:522 W RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0580
Mailing Address - Country:US
Mailing Address - Phone:760-821-7912
Mailing Address - Fax:
Practice Address - Street 1:49466 MOJAVE DR
Practice Address - Street 2:
Practice Address - City:MORONGO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92256-9740
Practice Address - Country:US
Practice Address - Phone:760-821-7912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty