Provider Demographics
NPI:1770266280
Name:GENESIS BIRTH DOULA SUPPORT, LLC
Entity type:Organization
Organization Name:GENESIS BIRTH DOULA SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/BIRTH DOULA
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:MELAINE
Authorized Official - Last Name:JONES-MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-304-5315
Mailing Address - Street 1:17216 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-3022
Mailing Address - Country:US
Mailing Address - Phone:937-304-5315
Mailing Address - Fax:
Practice Address - Street 1:17216 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-3022
Practice Address - Country:US
Practice Address - Phone:937-304-5315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty