Provider Demographics
NPI:1245964170
Name:SACRED SPACE MIDWIFERY
Entity type:Organization
Organization Name:SACRED SPACE MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:STAR
Authorized Official - Last Name:GARRIES
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:574-248-2485
Mailing Address - Street 1:16050 WAYNE ST.
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MI
Mailing Address - Zip Code:49130
Mailing Address - Country:US
Mailing Address - Phone:574-248-2485
Mailing Address - Fax:574-319-7689
Practice Address - Street 1:16050 WAYNE ST.
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MI
Practice Address - Zip Code:49130
Practice Address - Country:US
Practice Address - Phone:574-248-2485
Practice Address - Fax:574-319-7689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty