Provider Demographics
NPI:1366865362
Name:EDENS GARDEN BIRTH
Entity Type:Organization
Organization Name:EDENS GARDEN BIRTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:ROLLOGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-869-1225
Mailing Address - Street 1:5255 OLD COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:GOOCHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23063-2717
Mailing Address - Country:US
Mailing Address - Phone:804-869-1225
Mailing Address - Fax:
Practice Address - Street 1:5255 OLD COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GOOCHLAND
Practice Address - State:VA
Practice Address - Zip Code:23063-2717
Practice Address - Country:US
Practice Address - Phone:804-869-1225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty