Healthcare Provider Details

I. General information

NPI: 1063899904
Provider Name (Legal Business Name): THRIVE BIRTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4859 OLD REDWOOD HWY
SANTA ROSA CA
95403-1415
US

IV. Provider business mailing address

4859 OLD REDWOOD HWY
SANTA ROSA CA
95403-1415
US

V. Phone/Fax

Practice location:
  • Phone: 707-387-2088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM408
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM355
License Number StateCA

VIII. Authorized Official

Name: CAITLIN MARIE KIRKMAN
Title or Position: CEO
Credential: L.M., C.P.M.
Phone: 707-387-2088