Healthcare Provider Details

I. General information

NPI: 1104384353
Provider Name (Legal Business Name): CELESTIAL MIDWIFERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MAXWELL RD
SIMPSONVILLE SC
29681-5419
US

IV. Provider business mailing address

24 MAXWELL RD
SIMPSONVILLE SC
29681-5419
US

V. Phone/Fax

Practice location:
  • Phone: 864-203-5588
  • Fax: 877-243-1872
Mailing address:
  • Phone: 864-203-5588
  • Fax: 877-243-1872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: SHEILA DINEASE DELL
Title or Position: OWNER
Credential: CNM,MSN
Phone: 864-203-5588