Healthcare Provider Details

I. General information

NPI: 1336377886
Provider Name (Legal Business Name): THE BIRTH HOUSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 PACIFIC AVE SE
OLYMPIA WA
98506-4753
US

IV. Provider business mailing address

2120 PACIFIC AVE SE
OLYMPIA WA
98506-4753
US

V. Phone/Fax

Practice location:
  • Phone: 360-459-7222
  • Fax: 360-459-7223
Mailing address:
  • Phone: 360-459-7222
  • Fax: 360-459-7223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. CAROLEE A HALL
Title or Position: OWNER/MANAGER
Credential: LM
Phone: 360-459-7222