Healthcare Provider Details

I. General information

NPI: 1083061105
Provider Name (Legal Business Name): SIMPLYBORN/CEDARTREE BIRTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 LAKE DR SE 207
GRAND RAPIDS MI
49506-1447
US

IV. Provider business mailing address

959 LAKE DRIVE SUITE 207
GRAND RAPIDS MI
49506
US

V. Phone/Fax

Practice location:
  • Phone: 559-907-5341
  • Fax: 517-292-2452
Mailing address:
  • Phone: 559-907-5341
  • Fax: 517-292-2452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: SARA BADGER
Title or Position: OWNER
Credential: C.P.M
Phone: 559-907-5341