Healthcare Provider Details

I. General information

NPI: 1609473826
Provider Name (Legal Business Name): SACRED BIRTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 02/28/2023
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 RIVER DR
GUERNSEY WY
82201
US

IV. Provider business mailing address

754 E COLE ST
WHEATLAND WY
82201-8953
US

V. Phone/Fax

Practice location:
  • Phone: 307-331-7430
  • Fax: 307-939-2206
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: LACY MANSFIELD
Title or Position: MIDWIFE/OWNER
Credential:
Phone: 307-331-7430