Provider Demographics
NPI:1639792336
Name:HOME BIRTH SERVICES
Entity Type:Organization
Organization Name:HOME BIRTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LLM
Authorized Official - Phone:501-350-1520
Mailing Address - Street 1:6 EDENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-5106
Mailing Address - Country:US
Mailing Address - Phone:501-350-1520
Mailing Address - Fax:501-833-3322
Practice Address - Street 1:6 EDENWOOD LN
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-5106
Practice Address - Country:US
Practice Address - Phone:501-350-1520
Practice Address - Fax:501-833-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1225293731Medicaid