Provider Demographics
NPI:1790481182
Name:LILAC HEALTH MIDWIFERY GROUP OF ASHEVILLE
Entity Type:Organization
Organization Name:LILAC HEALTH MIDWIFERY GROUP OF ASHEVILLE
Other - Org Name:LILAC HEALTH MIDWIFERY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORGANIZING MEMBER AND OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAZELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:484-994-9196
Mailing Address - Street 1:390 S FRENCH BROAD AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4364
Mailing Address - Country:US
Mailing Address - Phone:828-970-5000
Mailing Address - Fax:
Practice Address - Street 1:390 S FRENCH BROAD AVE UNIT C
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4364
Practice Address - Country:US
Practice Address - Phone:828-970-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty