Provider Demographics
NPI:1285234351
Name:SACRED JOURNEY MIDWIFERY LLC
Entity type:Organization
Organization Name:SACRED JOURNEY MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCANSE
Authorized Official - Suffix:
Authorized Official - Credentials:APN, CNM
Authorized Official - Phone:385-274-6526
Mailing Address - Street 1:111 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-3728
Mailing Address - Country:US
Mailing Address - Phone:385-274-6526
Mailing Address - Fax:574-807-9575
Practice Address - Street 1:111 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-3728
Practice Address - Country:US
Practice Address - Phone:385-274-6526
Practice Address - Fax:574-807-9575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty