Provider Demographics
NPI:1770395725
Name:EARTHLY BALANCE PERINATAL CARE LLC
Entity type:Organization
Organization Name:EARTHLY BALANCE PERINATAL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEMPHIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:317-647-6689
Mailing Address - Street 1:PO BOX 18324
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-0324
Mailing Address - Country:US
Mailing Address - Phone:317-647-6689
Mailing Address - Fax:
Practice Address - Street 1:2023 BLUE PINE LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46231-5203
Practice Address - Country:US
Practice Address - Phone:317-647-6689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-24
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty