Provider Demographics
NPI:1700512100
Name:SACRED WOMBANHOOD BIRTH SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:SACRED WOMBANHOOD BIRTH SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PERINATAL DOULA / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-740-5096
Mailing Address - Street 1:276 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4318
Mailing Address - Country:US
Mailing Address - Phone:508-740-5096
Mailing Address - Fax:
Practice Address - Street 1:276 DIVISION ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4318
Practice Address - Country:US
Practice Address - Phone:508-740-5096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty