Provider Demographics
NPI:1063239507
Name:COMMON GRACE BIRTH SUPPORT
Entity type:Organization
Organization Name:COMMON GRACE BIRTH SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOULA
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:CD
Authorized Official - Phone:231-742-0050
Mailing Address - Street 1:3901 W TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:HART
Mailing Address - State:MI
Mailing Address - Zip Code:49420-8912
Mailing Address - Country:US
Mailing Address - Phone:231-742-3007
Mailing Address - Fax:
Practice Address - Street 1:405 E FOSTER ST
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2154
Practice Address - Country:US
Practice Address - Phone:231-742-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty