Provider Demographics
NPI:1487993275
Name:COMMUNITY BIRTH CENTER
Entity type:Organization
Organization Name:COMMUNITY BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:P. SHARISE
Authorized Official - Middle Name:SHARISE
Authorized Official - Last Name:CLOSTIO
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:406-257-5616
Mailing Address - Street 1:1320 2ND AVE E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5715
Mailing Address - Country:US
Mailing Address - Phone:406-260-4455
Mailing Address - Fax:
Practice Address - Street 1:1320 2ND AVE E
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5715
Practice Address - Country:US
Practice Address - Phone:406-260-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTANA MIDWIVES COOPERATIVE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing