Provider Demographics
NPI:1497251789
Name:HAVEN MIDWIFERY AND BIRTH CENTER
Entity Type:Organization
Organization Name:HAVEN MIDWIFERY AND BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETHEL
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:BELISLE
Authorized Official - Suffix:
Authorized Official - Credentials:CDM, CPM
Authorized Official - Phone:907-444-3027
Mailing Address - Street 1:12901 VON SCHEBEN DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-3268
Mailing Address - Country:US
Mailing Address - Phone:907-444-3027
Mailing Address - Fax:844-621-5905
Practice Address - Street 1:4050 LAKE OTIS PKWY STE 111
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5224
Practice Address - Country:US
Practice Address - Phone:907-444-3027
Practice Address - Fax:844-621-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK105776176B00000X, 261QB0400X
AK126457261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1022088Medicaid
AK1678481Medicaid