Healthcare Provider Details

I. General information

NPI: 1447514245
Provider Name (Legal Business Name): NEW BEGINNINGS BABY PLACE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 N LINDER RD
MERIDIAN ID
83642-2437
US

IV. Provider business mailing address

270 N LINDER RD
MERIDIAN ID
83642-2437
US

V. Phone/Fax

Practice location:
  • Phone: 208-884-1223
  • Fax: 208-887-1935
Mailing address:
  • Phone: 208-884-1223
  • Fax: 208-887-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number27360
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number27360
License Number StateID

VIII. Authorized Official

Name: KYLE SMITH
Title or Position: OWNER
Credential:
Phone: 208-884-1223