Provider Demographics
NPI:1114441771
Name:GENERATIONS HOME BIRTH, LLC
Entity Type:Organization
Organization Name:GENERATIONS HOME BIRTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:CPM
Authorized Official - Phone:208-569-9733
Mailing Address - Street 1:2650 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-7860
Mailing Address - Country:US
Mailing Address - Phone:208-360-2627
Mailing Address - Fax:208-549-7293
Practice Address - Street 1:2650 ROSS AVE
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-7860
Practice Address - Country:US
Practice Address - Phone:208-360-2627
Practice Address - Fax:208-549-7293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty