Healthcare Provider Details

I. General information

NPI: 1215100060
Provider Name (Legal Business Name): POPLAR HEIGHTS BIRTH AND WELLNESS CENTER, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 POPLAR STREET
PORT ORCHARD WA
98366
US

IV. Provider business mailing address

6954 SE TRUMAN ST
PORT ORCHARD WA
98366-8431
US

V. Phone/Fax

Practice location:
  • Phone: 360-329-6431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MR. KEVIN MICHAEL DECKER
Title or Position: MANAGER
Credential:
Phone: 360-329-6431