Provider Demographics
NPI:1770044984
Name:VITALITY HOME BIRTH
Entity Type:Organization
Organization Name:VITALITY HOME BIRTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:FISCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:202-747-4757
Mailing Address - Street 1:24 FRAZER RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:VT
Mailing Address - Zip Code:05680-3030
Mailing Address - Country:US
Mailing Address - Phone:202-747-4757
Mailing Address - Fax:
Practice Address - Street 1:1037 S CRAFTSBURY RD
Practice Address - Street 2:
Practice Address - City:CRAFTSBURY
Practice Address - State:VT
Practice Address - Zip Code:05826-9008
Practice Address - Country:US
Practice Address - Phone:202-747-4757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1070129905OtherLM
19030018OtherCPM