Provider Demographics
NPI:1184806176
Name:INTEGRATED WELLNESS & CENTER FOR BIRTH, LLC
Entity type:Organization
Organization Name:INTEGRATED WELLNESS & CENTER FOR BIRTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:G
Authorized Official - Last Name:ELROD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-357-7781
Mailing Address - Street 1:1301 W PARKS HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6939
Mailing Address - Country:US
Mailing Address - Phone:907-357-7781
Mailing Address - Fax:907-357-7786
Practice Address - Street 1:1301 W PARKS HWY STE 101
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6939
Practice Address - Country:US
Practice Address - Phone:907-357-7781
Practice Address - Fax:907-357-7786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020589Medicaid
AKK162087Medicare PIN