Provider Demographics
NPI:1013483791
Name:MOONRISE HEALTH AND BIRTH, INC
Entity type:Organization
Organization Name:MOONRISE HEALTH AND BIRTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LM
Authorized Official - Phone:206-930-6027
Mailing Address - Street 1:5720 220TH ST SW STE A
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-3137
Mailing Address - Country:US
Mailing Address - Phone:425-670-6752
Mailing Address - Fax:888-691-3151
Practice Address - Street 1:5720 220TH ST SW STE A
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-3137
Practice Address - Country:US
Practice Address - Phone:425-670-6752
Practice Address - Fax:888-691-3151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No175M00000XOther Service ProvidersMidwife, LayGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7135726Medicaid