Provider Demographics
NPI:1639689516
Name:SACREDME
Entity type:Organization
Organization Name:SACREDME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LAY MIDWIFE/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLOYA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ADEDAPOIDLE TYEHIMBA-FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DOULA, CEO
Authorized Official - Phone:925-250-5400
Mailing Address - Street 1:623 SHADDICK DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-5044
Mailing Address - Country:US
Mailing Address - Phone:510-691-5169
Mailing Address - Fax:
Practice Address - Street 1:623 SHADDICK DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-5044
Practice Address - Country:US
Practice Address - Phone:510-691-5169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251V00000X, 253Z00000X, 261QB0400X, 305S00000X, 282J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
No251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA99501Medicaid
CA99502Medicaid
CA99499Medicaid