Provider Demographics
NPI:1164247110
Name:PIVOTAL BIRTH LLC
Entity type:Organization
Organization Name:PIVOTAL BIRTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-364-2944
Mailing Address - Street 1:6024 WILLOW SONG CT
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-2774
Mailing Address - Country:US
Mailing Address - Phone:910-364-2942
Mailing Address - Fax:
Practice Address - Street 1:6024 WILLOW SONG CT
Practice Address - Street 2:
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-2774
Practice Address - Country:US
Practice Address - Phone:910-364-2942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service