Provider Demographics
NPI:1033596259
Name:FABULOUS BIRTH SUPPORT
Entity Type:Organization
Organization Name:FABULOUS BIRTH SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDING DIRECTOR AND DOULA
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:WONDERLAND
Authorized Official - Last Name:BACICH
Authorized Official - Suffix:
Authorized Official - Credentials:CLC
Authorized Official - Phone:562-774-3289
Mailing Address - Street 1:2655 8TH AVE
Mailing Address - Street 2:APT 4N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-1536
Mailing Address - Country:US
Mailing Address - Phone:562-774-3289
Mailing Address - Fax:
Practice Address - Street 1:2655 8TH AVE
Practice Address - Street 2:APT 4N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-1536
Practice Address - Country:US
Practice Address - Phone:562-774-3289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty