Healthcare Provider Details

I. General information

NPI: 1073718607
Provider Name (Legal Business Name): MOTHER'S OWN BIRTH AND WOMEN'S CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 W DEAN RD SUITE C
TEMPERANCE MI
48182-9406
US

IV. Provider business mailing address

1715 W DEAN RD SUITE C
TEMPERANCE MI
48182-9406
US

V. Phone/Fax

Practice location:
  • Phone: 734-847-8100
  • Fax: 734-847-6824
Mailing address:
  • Phone: 734-847-8100
  • Fax: 734-847-6824

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: LINDA R. JOHNSON
Title or Position: OWNER
Credential: CNM
Phone: 734-847-8100