=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154213494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAGNOLIA BIRTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2025
-----------------------------------------------------
Last Update Date | 07/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4081 W HARRISON RD
-----------------------------------------------------
City | ALMA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48801-9639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-427-7868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4081 W HARRISON RD
-----------------------------------------------------
City | ALMA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48801-9639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-427-7868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KALEIGH PETTIGREW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 616-427-7868
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------