Healthcare Provider Details

I. General information

NPI: 1821336074
Provider Name (Legal Business Name): VILLAGE BIRTH COOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7403 FLOWER AVE APT 1
TAKOMA PARK MD
20912-6459
US

IV. Provider business mailing address

7403 FLOWER AVE APT 1
TAKOMA PARK MD
20912-6459
US

V. Phone/Fax

Practice location:
  • Phone: 202-643-8317
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. AZA NEDHARI
Title or Position: CO-OWNER
Credential:
Phone: 202-643-8317