Provider Demographics
NPI:1619162500
Name:CHARLESTON BIRTH PLACE, INC
Entity type:Organization
Organization Name:CHARLESTON BIRTH PLACE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RATHBUN
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:843-818-1123
Mailing Address - Street 1:1300 HOSPITAL DR STE 270
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3244
Mailing Address - Country:US
Mailing Address - Phone:843-818-1123
Mailing Address - Fax:843-818-1126
Practice Address - Street 1:9133 TIMBER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-818-1123
Practice Address - Fax:843-818-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCBC-007261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4823Medicaid