Provider Demographics
NPI:1992860852
Name:A IN HOME BIRTH CENTER, INC.
Entity Type:Organization
Organization Name:A IN HOME BIRTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:VANITA
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CNM
Authorized Official - Phone:530-477-7333
Mailing Address - Street 1:10476 WALKER DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-6021
Mailing Address - Country:US
Mailing Address - Phone:530-477-7333
Mailing Address - Fax:530-477-7440
Practice Address - Street 1:10476 WALKER DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6021
Practice Address - Country:US
Practice Address - Phone:530-477-7333
Practice Address - Fax:530-477-7440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW1275367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANMW012750Medicaid