Healthcare Provider Details

I. General information

NPI: 1275437741
Provider Name (Legal Business Name): MOON AND TIDE BIRTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 OLD NORTH RD
KINGSTON RI
02881-1208
US

IV. Provider business mailing address

481 OLD NORTH RD
KINGSTON RI
02881-1208
US

V. Phone/Fax

Practice location:
  • Phone: 978-868-2350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERYNN MILLS
Title or Position: OWNER
Credential:
Phone: 978-868-2350