1104384353 NPI number — CELESTIAL MIDWIFERY SERVICES LLC

Table of content: (NPI 1104384353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104384353 NPI number — CELESTIAL MIDWIFERY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CELESTIAL MIDWIFERY SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104384353
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 MAXWELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMPSONVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29681-5419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-203-5588
Provider Business Mailing Address Fax Number:
877-243-1872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 MAXWELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIMPSONVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29681-5419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-203-5588
Provider Business Practice Location Address Fax Number:
877-243-1872
Provider Enumeration Date:
03/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
DELL
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
DINEASE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
864-203-5588

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GP9104 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1104106442 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CNM0282 . This is a "AMCB" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: MW0426 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: APN20137 . This is a "BOARD OF NURSING SC" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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