Provider Demographics
NPI:1740711654
Name:PEACEFUL LOVING DOULA SERVICE
Entity type:Organization
Organization Name:PEACEFUL LOVING DOULA SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOULA
Authorized Official - Prefix:
Authorized Official - First Name:DANAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JESFJELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-331-8425
Mailing Address - Street 1:5172 COORS BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-6263
Mailing Address - Country:US
Mailing Address - Phone:505-331-8425
Mailing Address - Fax:
Practice Address - Street 1:5172 COORS BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-6263
Practice Address - Country:US
Practice Address - Phone:505-331-8425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1407309487Medicaid