Provider Demographics
NPI:1770880429
Name:CENTER FOR BIRTH, LLC
Entity type:Organization
Organization Name:CENTER FOR BIRTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER, DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TSIAKALIS
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:206-369-5315
Mailing Address - Street 1:1500 EASTLAKE AVE E
Mailing Address - Street 2:1500 EASTLAKE AVE E
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3707
Mailing Address - Country:US
Mailing Address - Phone:206-407-3397
Mailing Address - Fax:206-407-3775
Practice Address - Street 1:1500 EASTLAKE AVE E
Practice Address - Street 2:1500 EASTLAKE AVE E
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3707
Practice Address - Country:US
Practice Address - Phone:206-407-3397
Practice Address - Fax:206-407-3775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACBC FS 60203814261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2006375Medicaid