MEDICARE: AHAVAH BIRTHWORKS

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1669842209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AHAVAH BIRTHWORKS

Provider Business Mailing Address
First Line	:	2512 WEST BROADWAY AVE NORTH
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55429
Country	:	US
Telephone Number	:	612-354-2629
Fax Number	:

Provider Business Practice Location Address
First Line	:	2512 W BROADWAY AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-1737
Country	:	US
Telephone Number	:	612-354-2629
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. CLARA SHARP
Credential	:	CD
Telephone Number	:	763-516-6148

Provider Enumeration Date	:	09/25/2015
Last Update Date	:	09/25/2015

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Directions to “AHAVAH BIRTHWORKS ” Practice Location

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