Provider Demographics
NPI:1972260172
Name:COMMUNITY BIRTH CENTER
Entity Type:Organization
Organization Name:COMMUNITY BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOTHYRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHI
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:360-481-0105
Mailing Address - Street 1:3663 COLLEGE ST SE STE C
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2303
Mailing Address - Country:US
Mailing Address - Phone:360-481-0105
Mailing Address - Fax:360-764-2724
Practice Address - Street 1:3663 COLLEGE ST SE STE C
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2303
Practice Address - Country:US
Practice Address - Phone:360-481-0105
Practice Address - Fax:360-764-2724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Single Specialty