Provider Demographics
NPI:1235509183
Name:LITTLE STAR BIRTH SERVICES, LLC
Entity Type:Organization
Organization Name:LITTLE STAR BIRTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:571-438-3224
Mailing Address - Street 1:21010 SOUTHBANK ST # 2050
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-7227
Mailing Address - Country:US
Mailing Address - Phone:571-438-3224
Mailing Address - Fax:
Practice Address - Street 1:10305 YORKTOWN CT
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-4217
Practice Address - Country:US
Practice Address - Phone:571-438-3224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000102176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty