Provider Demographics
NPI:1336517234
Name:LABOR OF LOVE FAMILY BIRTH CENTER, LLC
Entity Type:Organization
Organization Name:LABOR OF LOVE FAMILY BIRTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTOX
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:407-625-0482
Mailing Address - Street 1:990 BROADWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5763
Mailing Address - Country:US
Mailing Address - Phone:727-734-2229
Mailing Address - Fax:727-734-8855
Practice Address - Street 1:990 BROADWAY
Practice Address - Street 2:SUITE C
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5763
Practice Address - Country:US
Practice Address - Phone:727-734-2229
Practice Address - Fax:727-734-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL295261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing