Provider Demographics
NPI:1023711884
Name:VILLAGE SIS DOULA, LLC
Entity type:Organization
Organization Name:VILLAGE SIS DOULA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CASSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPP-AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-580-7405
Mailing Address - Street 1:4921 TOWER RD APT B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-5715
Mailing Address - Country:US
Mailing Address - Phone:336-580-7405
Mailing Address - Fax:
Practice Address - Street 1:4921 TOWER RD APT B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-5715
Practice Address - Country:US
Practice Address - Phone:336-580-7405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty