Provider Demographics
NPI:1073901542
Name:TLC FOR MOMS 2 B,LLC
Entity Type:Organization
Organization Name:TLC FOR MOMS 2 B,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DERWART-REH
Authorized Official - Suffix:
Authorized Official - Credentials:CPM
Authorized Official - Phone:717-698-8524
Mailing Address - Street 1:2 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2040
Mailing Address - Country:US
Mailing Address - Phone:717-698-8524
Mailing Address - Fax:186-677-4927
Practice Address - Street 1:2 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2040
Practice Address - Country:US
Practice Address - Phone:717-698-8524
Practice Address - Fax:186-677-4927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA14060007176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty