MEDICARE: THRIVE CENTER FOR BIRTH & FAMILY WELLNESS, INC

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	LM355	CA
2	176B00000X	Midwife	LM117	CA

General Provider Information

NPI Number	:	1205275690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE CENTER FOR BIRTH & FAMILY WELLNESS, INC

Provider Business Mailing Address
First Line	:	4859 OLD REDWOOD HWY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1415
Country	:	US
Telephone Number	:	707-387-2088
Fax Number	:	707-324-5582

Provider Business Practice Location Address
First Line	:	4859 OLD REDWOOD HWY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1415
Country	:	US
Telephone Number	:	707-387-2088
Fax Number	:	707-324-5582

Authorized Official
Title or Position	:	CEO
Name	:	MS. CAITLIN MARIE KIRKMAN
Credential	:	LM, CPM
Telephone Number	:	707-387-2088

Provider Enumeration Date	:	06/18/2013
Last Update Date	:	02/27/2015

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