Provider Demographics
NPI:1982058491
Name:ROGUE BIRTH CENTER LLC
Entity Type:Organization
Organization Name:ROGUE BIRTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WOODARD ERVIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LDM
Authorized Official - Phone:541-210-0134
Mailing Address - Street 1:1453 REDWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5523
Mailing Address - Country:US
Mailing Address - Phone:541-210-0134
Mailing Address - Fax:
Practice Address - Street 1:1453 REDWOOD CIR
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5523
Practice Address - Country:US
Practice Address - Phone:541-210-0134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Single Specialty