Healthcare Provider Details

I. General information

NPI: 1205498532
Provider Name (Legal Business Name): WELCOME HOME COMMUNITY BIRTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 47TH AVE STE 5
SACRAMENTO CA
95824-3848
US

IV. Provider business mailing address

PMB 302, 5960 SOUTH LAND PARK DRIVE
SACRAMENTO CA
95822
US

V. Phone/Fax

Practice location:
  • Phone: 916-668-9467
  • Fax: 209-336-6814
Mailing address:
  • Phone: 916-668-9467
  • Fax: 209-336-6814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MADELEINE JUSTINE WISNER
Title or Position: PRESIDENT
Credential: LM
Phone: 916-668-9467