MEDICARE: SACRED BLACKSTONE BIRTH ADVOCATES

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	374J00000X	Doula

General Provider Information

NPI Number	:	1477429629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED BLACKSTONE BIRTH ADVOCATES

Provider Business Mailing Address
First Line	:	756 PIPESTONE ST # 4
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-4845
Country	:	US
Telephone Number	:	616-315-7101
Fax Number	:

Provider Business Practice Location Address
First Line	:	756 PIPESTONE ST # 2
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-4845
Country	:	US
Telephone Number	:	616-315-7101
Fax Number	:

Authorized Official
Title or Position	:	DOULA
Name	:	MRS. JONELL TONE SAWYER-MOORE
Credential	:	CERTIFIED DOULA
Telephone Number	:	616-315-7101

Provider Enumeration Date	:	10/15/2025
Last Update Date	:	10/15/2025

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