Provider Demographics
NPI:1255875274
Name:CHERISHED BIRTH, LLC
Entity type:Organization
Organization Name:CHERISHED BIRTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELENA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:SANDIFER
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:903-316-8337
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:VAN
Mailing Address - State:TX
Mailing Address - Zip Code:75790-0351
Mailing Address - Country:US
Mailing Address - Phone:903-316-8337
Mailing Address - Fax:903-280-7686
Practice Address - Street 1:215 S VINE AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7143
Practice Address - Country:US
Practice Address - Phone:903-316-8337
Practice Address - Fax:903-280-7686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150050261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Single Specialty