Healthcare Provider Details

I. General information

NPI: 1659937597
Provider Name (Legal Business Name): JAMAA BIRTH VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 09/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CHURCH ST
FERGUSON MO
63135-2409
US

IV. Provider business mailing address

8 CHURCH ST
FERGUSON MO
63135-2409
US

V. Phone/Fax

Practice location:
  • Phone: 314-643-7703
  • Fax: 314-736-5550
Mailing address:
  • Phone: 314-643-7703
  • Fax: 314-736-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRITTANY L CAMPBELL-KELLMAN
Title or Position: EXECUTIVE & CLINICAL DIRECTOR
Credential: CD,CPM,CLC
Phone: 314-643-7703