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General NPI Number Information
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NPI Number | 1134548936
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Entity Type | Organization
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Legal Business Name | GRAPEVINE BIRTHING CENTER
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 409 W WALL ST
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City | GRAPEVINE
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State | TX
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Zip | 76051-5203
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Country | US
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Telephone | 214-563-7410
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Fax |
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Provider Business Mailing Address
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Address Line | 409 W WALL ST
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City | GRAPEVINE
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State | TX
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Zip | 76051-5203
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Country | US
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Telephone | 214-563-7410
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Fax |
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Authorized Official
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Title or Position | OWNER/MIDWIFE
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Name | KIMBERLY DALY
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Credential | LM, CPM
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Telephone | 214-563-7410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number | 150036
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License Number State | TX
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