Provider Demographics
NPI:1548643745
Name:BEAUTIFUL MOUNTAIN BIRTH SUITES, LLC
Entity type:Organization
Organization Name:BEAUTIFUL MOUNTAIN BIRTH SUITES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/EDUCATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LDEM
Authorized Official - Phone:801-252-6243
Mailing Address - Street 1:826 E 12300 S STE 2
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8276
Mailing Address - Country:US
Mailing Address - Phone:801-252-6243
Mailing Address - Fax:801-892-0788
Practice Address - Street 1:826 E 12300 S STE 2
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8276
Practice Address - Country:US
Practice Address - Phone:801-252-6243
Practice Address - Fax:801-892-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing