MEDICARE: SIMPLYBORN/CEDARTREE BIRTH & WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife

General Provider Information

NPI Number	:	1083061105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLYBORN/CEDARTREE BIRTH & WELLNESS

Provider Business Mailing Address
First Line	:	959 LAKE DRIVE
Second Line	:	SUITE 207
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506
Country	:	US
Telephone Number	:	559-907-5341
Fax Number	:	517-292-2452

Provider Business Practice Location Address
First Line	:	959 LAKE DR SE
Second Line	:	207
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-1447
Country	:	US
Telephone Number	:	559-907-5341
Fax Number	:	517-292-2452

Authorized Official
Title or Position	:	OWNER
Name	:	SARA BADGER
Credential	:	C.P.M
Telephone Number	:	559-907-5341

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	05/18/2016

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Directions to “SIMPLYBORN/CEDARTREE BIRTH & WELLNESS ” Practice Location

Language	Start Address	Practice Location

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