Provider Demographics
NPI:1912232992
Name:ELEMENTAL BIRTH, LLC
Entity Type:Organization
Organization Name:ELEMENTAL BIRTH, LLC
Other - Org Name:SNOHOMISH MIDWIVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MIDWIFE/MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DENMARK
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:206-724-5303
Mailing Address - Street 1:5719 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-5013
Mailing Address - Country:US
Mailing Address - Phone:877-869-6105
Mailing Address - Fax:360-563-2662
Practice Address - Street 1:57 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2929
Practice Address - Country:US
Practice Address - Phone:877-869-6105
Practice Address - Fax:360-563-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000286261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7136716Medicaid