MEDICARE: GENTLE BIRTHING IN SOUTHEAST MICHIGAN, LLC

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	:	1902617111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE BIRTHING IN SOUTHEAST MICHIGAN, LLC

Provider Business Mailing Address
First Line	:	2861 CHURCH RD
Second Line	:
City	:	COLUMBUS
State	:	MI
Zip	:	48063-4216
Country	:	US
Telephone Number	:	803-207-4701
Fax Number	:

Provider Business Practice Location Address
First Line	:	2861 CHURCH RD
Second Line	:
City	:	COLUMBUS
State	:	MI
Zip	:	48063-4216
Country	:	US
Telephone Number	:	810-278-4974
Fax Number	:

Authorized Official
Title or Position	:	DOULA
Name	:	STEPHANIE EBERLY
Credential	:
Telephone Number	:	810-278-4974

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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