Healthcare Provider Details

I. General information

NPI: 1184015596
Provider Name (Legal Business Name): COMMON SENSE CHILD BIRTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2015
Last Update Date: 02/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S DILLARD ST SUITE #340
WINTER GARDEN FL
34787-3522
US

IV. Provider business mailing address

213 S DILLARD ST SUITE #340
WINTER GARDEN FL
34787-3522
US

V. Phone/Fax

Practice location:
  • Phone: 407-656-6938
  • Fax:
Mailing address:
  • Phone: 407-656-6938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5694
License Number StateFM
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. JENNIE JOSEPH
Title or Position: EXECUTIVE DIRECTOR
Credential: CPM
Phone: 407-656-6938