Provider Demographics
NPI:1184078750
Name:NORTH STAR DOULA SERVICE LLC
Entity type:Organization
Organization Name:NORTH STAR DOULA SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BIRTH DOULA
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:CD
Authorized Official - Phone:503-753-4871
Mailing Address - Street 1:4585 LEIF ERIKSON DR
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-2221
Mailing Address - Country:US
Mailing Address - Phone:503-753-4871
Mailing Address - Fax:
Practice Address - Street 1:4585 LEIF ERIKSON DR
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-2221
Practice Address - Country:US
Practice Address - Phone:503-753-4871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty