Provider Demographics
NPI:1497281075
Name:TREE OF LIFE BIRTH CENTER
Entity Type:Organization
Organization Name:TREE OF LIFE BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:CPM LM
Authorized Official - Phone:540-841-4863
Mailing Address - Street 1:1003 MAHONE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-6214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1003 MAHONE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-6214
Practice Address - Country:US
Practice Address - Phone:540-841-4863
Practice Address - Fax:540-227-7472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000114176B00000X
VA0129000033176B00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1295196954OtherNPI
VA1487835492OtherNPI
VA1295196954OtherNPI