Provider Demographics
NPI:1962985945
Name:WHOLE HEARTED BIRTH, LLC
Entity type:Organization
Organization Name:WHOLE HEARTED BIRTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:208-360-1703
Mailing Address - Street 1:9732 N 70TH E
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5566
Mailing Address - Country:US
Mailing Address - Phone:208-360-1703
Mailing Address - Fax:208-550-3294
Practice Address - Street 1:9732 N 70TH E
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-5566
Practice Address - Country:US
Practice Address - Phone:208-360-1703
Practice Address - Fax:208-550-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDIDTPID012834Medicaid