Healthcare Provider Details

I. General information

NPI: 1669842209
Provider Name (Legal Business Name): AHAVAH BIRTHWORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 W BROADWAY AVE
MINNEAPOLIS MN
55411-1737
US

IV. Provider business mailing address

2512 WEST BROADWAY AVE NORTH
MINNEAPOLIS MN
55429
US

V. Phone/Fax

Practice location:
  • Phone: 612-354-2629
  • Fax:
Mailing address:
  • Phone: 612-354-2629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CLARA SHARP
Title or Position: EXECUTIVE DIRECTOR
Credential: CD
Phone: 763-516-6148