Provider Demographics
NPI:1720400310
Name:ROOTMAMA MATERNAL CARE
Entity Type:Organization
Organization Name:ROOTMAMA MATERNAL CARE
Other - Org Name:ROOTMAMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOULA
Authorized Official - Prefix:MS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:CD
Authorized Official - Phone:202-270-1080
Mailing Address - Street 1:3903 MELEAR DR UNIT 151681
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4870
Mailing Address - Country:US
Mailing Address - Phone:682-587-7668
Mailing Address - Fax:
Practice Address - Street 1:3903 MELEAR DR UNIT 151681
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4870
Practice Address - Country:US
Practice Address - Phone:682-587-7668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR001374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1234OtherUNKNOWN