Provider Demographics
NPI:1295964138
Name:CENTREVIDA BIRTH AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:CENTREVIDA BIRTH AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLIE
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:BELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:512-698-4132
Mailing Address - Street 1:7002 MANCHACA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5352
Mailing Address - Country:US
Mailing Address - Phone:512-442-2229
Mailing Address - Fax:
Practice Address - Street 1:7002 MANCHACA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5352
Practice Address - Country:US
Practice Address - Phone:512-442-2229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150001261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing