Provider Demographics
NPI:1164697504
Name:ONE FAMILY, LLC
Entity Type:Organization
Organization Name:ONE FAMILY, LLC
Other - Org Name:ONE FAMILY BIRTH CENTER & WOMEN'S WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:TIESZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-250-1944
Mailing Address - Street 1:PO BOX 112381
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-2381
Mailing Address - Country:US
Mailing Address - Phone:907-349-3054
Mailing Address - Fax:907-349-3056
Practice Address - Street 1:1108 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:STE C
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4219
Practice Address - Country:US
Practice Address - Phone:907-349-3054
Practice Address - Fax:907-349-3056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOTHER'S HEARTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-27
Last Update Date:2008-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKONF02030000001261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKONF02030000001OtherSTATE LICENSE FACILTY ID