Provider Demographics
NPI:1275251654
Name:A MOTHER'S VILLAGE, LLC
Entity Type:Organization
Organization Name:A MOTHER'S VILLAGE, LLC
Other - Org Name:A MOTHER'S VILLAGE BIRTH CENTER OF OCALA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MERRELL
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:352-470-7565
Mailing Address - Street 1:12285 SE 70TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-4673
Mailing Address - Country:US
Mailing Address - Phone:352-470-7565
Mailing Address - Fax:352-900-1978
Practice Address - Street 1:5455 SE MARICAMP RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480-7417
Practice Address - Country:US
Practice Address - Phone:352-470-7565
Practice Address - Fax:352-900-1978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A MOTHER'S VILLAGE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-22
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMW408Medicaid