Provider Demographics
NPI:1134548936
Name:GRAPEVINE BIRTHING CENTER
Entity type:Organization
Organization Name:GRAPEVINE BIRTHING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:214-563-7410
Mailing Address - Street 1:409 W WALL ST
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5203
Mailing Address - Country:US
Mailing Address - Phone:214-563-7410
Mailing Address - Fax:
Practice Address - Street 1:409 W WALL ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5203
Practice Address - Country:US
Practice Address - Phone:214-563-7410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150036261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing