Healthcare Provider Details

I. General information

NPI: 1275251654
Provider Name (Legal Business Name): A MOTHER'S VILLAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 SE MARICAMP RD
OCALA FL
34480-7417
US

IV. Provider business mailing address

12285 SE 70TH AVENUE RD
BELLEVIEW FL
34420-4673
US

V. Phone/Fax

Practice location:
  • Phone: 352-470-7565
  • Fax: 352-900-1978
Mailing address:
  • Phone: 352-470-7565
  • Fax: 352-900-1978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBECCA MERRELL CARLSON
Title or Position: OWNER
Credential: LM, CPM
Phone: 352-470-7565