Healthcare Provider Details

I. General information

NPI: 1306161302
Provider Name (Legal Business Name): BROOKHAVEN HEALTH AND NATURAL BIRTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 BROOKHAVEN DR
HARRISONBURG VA
22801-3584
US

IV. Provider business mailing address

8729 CHESTERFIELD LN
BRIDGEWATER VA
22812-3725
US

V. Phone/Fax

Practice location:
  • Phone: 540-830-4462
  • Fax:
Mailing address:
  • Phone: 540-830-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number0129000054
License Number StateVA

VIII. Authorized Official

Name: MISTY DAWN WARD
Title or Position: MIDWIFE
Credential: CPM
Phone: 540-830-4462