Healthcare Provider Details

I. General information

NPI: 1619503976
Provider Name (Legal Business Name): THE NATURAL BIRTHHOUSE - NORTHSHORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 GREENBRIER BLVD STE 101
COVINGTON LA
70433-7237
US

IV. Provider business mailing address

803 S MORGAN AVE
BROUSSARD LA
70518-4921
US

V. Phone/Fax

Practice location:
  • Phone: 337-453-4346
  • Fax:
Mailing address:
  • Phone: 337-453-4346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY BERGERON
Title or Position: BIRTH CENTER DIRECTOR
Credential:
Phone: 337-453-4346