Provider Demographics
NPI:1174981864
Name:A NEW STORY BIRTH CENTER
Entity type:Organization
Organization Name:A NEW STORY BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MIDWIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SAHLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, RN, CST, SNHP
Authorized Official - Phone:320-362-0476
Mailing Address - Street 1:16802 145TH AVE
Mailing Address - Street 2:
Mailing Address - City:MILACA
Mailing Address - State:MN
Mailing Address - Zip Code:56353-3208
Mailing Address - Country:US
Mailing Address - Phone:320-362-0476
Mailing Address - Fax:320-983-2998
Practice Address - Street 1:16802 145TH AVE
Practice Address - Street 2:
Practice Address - City:MILACA
Practice Address - State:MN
Practice Address - Zip Code:56353-3208
Practice Address - Country:US
Practice Address - Phone:320-362-0476
Practice Address - Fax:320-983-2998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAIROS MIDWIFERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN375294261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing