Provider Demographics
NPI:1780126433
Name:BREATH OF MY HEART BIRTHPLACE
Entity type:Organization
Organization Name:BREATH OF MY HEART BIRTHPLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLENNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:505-753-0505
Mailing Address - Street 1:905 CALLE ARMADA
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532
Mailing Address - Country:US
Mailing Address - Phone:505-753-0505
Mailing Address - Fax:505-212-0420
Practice Address - Street 1:905 CALLE ARMADA
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532
Practice Address - Country:US
Practice Address - Phone:505-753-0505
Practice Address - Fax:505-212-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-12
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM09065R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty