Provider Demographics
NPI:1831407931
Name:ONE FAMILY BIRTH & WELLNESS CENTER
Entity type:Organization
Organization Name:ONE FAMILY BIRTH & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BASTANI
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:907-349-3054
Mailing Address - Street 1:1108 E NORTHERN LIGHTS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4259
Mailing Address - Country:US
Mailing Address - Phone:907-349-3054
Mailing Address - Fax:907-349-3056
Practice Address - Street 1:1108 E NORTHERN LIGHTS BLVD STE C
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4259
Practice Address - Country:US
Practice Address - Phone:907-349-3054
Practice Address - Fax:907-349-3056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKONF02030000001261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKONF02030000001OtherSTATE OF ALASKA FACILITY LICENSE