Provider Demographics
NPI:1669704052
Name:HOME SWEET HOME BIRTH CENTER, LLC
Entity type:Organization
Organization Name:HOME SWEET HOME BIRTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LUXFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LDM-CPM
Authorized Official - Phone:541-996-3968
Mailing Address - Street 1:3013 N NORTH BANK RD
Mailing Address - Street 2:
Mailing Address - City:OTIS
Mailing Address - State:OR
Mailing Address - Zip Code:97368-9754
Mailing Address - Country:US
Mailing Address - Phone:541-996-3968
Mailing Address - Fax:541-996-6353
Practice Address - Street 1:3013 N NORTH BANK RD
Practice Address - Street 2:
Practice Address - City:OTIS
Practice Address - State:OR
Practice Address - Zip Code:97368-9754
Practice Address - Country:US
Practice Address - Phone:541-996-3968
Practice Address - Fax:541-996-6353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07-1569261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1205960093Medicaid