Provider Demographics
NPI:1770378093
Name:SHILOH BIRTH LLC
Entity type:Organization
Organization Name:SHILOH BIRTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOULA
Authorized Official - Prefix:
Authorized Official - First Name:RAELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:CD
Authorized Official - Phone:575-420-5200
Mailing Address - Street 1:1013 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-8259
Mailing Address - Country:US
Mailing Address - Phone:575-420-5200
Mailing Address - Fax:
Practice Address - Street 1:1013 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-8259
Practice Address - Country:US
Practice Address - Phone:575-420-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-09
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty