Provider Demographics
NPI:1295433647
Name:HUMBOLDT COUNTY DOULA LLC
Entity type:Organization
Organization Name:HUMBOLDT COUNTY DOULA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER, DOULA
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:LEACH
Authorized Official - Last Name:MACHADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-979-4460
Mailing Address - Street 1:55 WEIRUP LN APT 1
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-5312
Mailing Address - Country:US
Mailing Address - Phone:515-979-4460
Mailing Address - Fax:
Practice Address - Street 1:55 WEIRUP LN APT 1
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-5312
Practice Address - Country:US
Practice Address - Phone:515-979-4460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty