Provider Demographics
NPI:1821399460
Name:LABOR OF LOVE MIDWIFERY, LLC
Entity Type:Organization
Organization Name:LABOR OF LOVE MIDWIFERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HALSEY
Authorized Official - Suffix:
Authorized Official - Credentials:CDM, CPM
Authorized Official - Phone:907-841-2565
Mailing Address - Street 1:PO BOX 874486
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99587-4486
Mailing Address - Country:US
Mailing Address - Phone:907-841-2565
Mailing Address - Fax:888-862-1422
Practice Address - Street 1:2405 S. KNIK GOOSE BAY ROAD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-841-2565
Practice Address - Fax:888-862-1422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNM0044175M00000X
AKFBC-014261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175M00000XOther Service ProvidersMidwife, LayGroup - Single Specialty
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1571125Medicaid