Healthcare Provider Details

I. General information

NPI: 1447374400
Provider Name (Legal Business Name): COASTAL FAMILY BIRTH RETREAT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 FRYING PAN LN
STRATHAM NH
03885-2506
US

IV. Provider business mailing address

13 FRYING PAN LN
STRATHAM NH
03885-2506
US

V. Phone/Fax

Practice location:
  • Phone: 603-580-2327
  • Fax: 603-580-2326
Mailing address:
  • Phone: 603-580-2327
  • Fax: 603-580-2326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number1009
License Number StateNH

VIII. Authorized Official

Name: VALERIE ANN JACQUES
Title or Position: OWNER, ADMINISTRATOR
Credential: RN, CPM, NHCM
Phone: 603-580-2327