Healthcare Provider Details

I. General information

NPI: 1710850870
Provider Name (Legal Business Name): BIRTH WELL SHREVEPORT NONPROFIT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLIVE ST
SHREVEPORT LA
71104-2103
US

IV. Provider business mailing address

915 OLIVE ST
SHREVEPORT LA
71104-2103
US

V. Phone/Fax

Practice location:
  • Phone: 318-754-6656
  • Fax:
Mailing address:
  • Phone: 318-754-6656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ALICIA MINGO
Title or Position: FOUNDER/DIRECTOR
Credential:
Phone: 318-219-6640