Healthcare Provider Details

I. General information

NPI: 1255875274
Provider Name (Legal Business Name): CHERISHED BIRTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S VINE AVE
TYLER TX
75702-7143
US

IV. Provider business mailing address

PO BOX 351
VAN TX
75790-0351
US

V. Phone/Fax

Practice location:
  • Phone: 903-316-8337
  • Fax: 903-280-7686
Mailing address:
  • Phone: 903-316-8337
  • Fax: 903-280-7686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number150050
License Number StateTX

VIII. Authorized Official

Name: MRS. MELENA RUTH SANDIFER
Title or Position: OWNER/ADMINISTRATOR
Credential: CPM, LM
Phone: 903-316-8337