Provider Demographics
NPI:1831733021
Name:GENESIS BIRTH SERVICES LLC
Entity type:Organization
Organization Name:GENESIS BIRTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GERRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:CLC CD CBE CHW MH MA
Authorized Official - Phone:717-970-3009
Mailing Address - Street 1:1307 PARK AVE
Mailing Address - Street 2:#10
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701
Mailing Address - Country:US
Mailing Address - Phone:717-970-3009
Mailing Address - Fax:
Practice Address - Street 1:1307 PARK AVE
Practice Address - Street 2:#10
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-2610
Practice Address - Country:US
Practice Address - Phone:717-970-3009
Practice Address - Fax:717-970-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty