Healthcare Provider Details

I. General information

NPI: 1396687331
Provider Name (Legal Business Name): MERAKI COMMUNITY BIRTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W STATE ST
ITHACA NY
14850-5431
US

IV. Provider business mailing address

301 W STATE ST
ITHACA NY
14850-5431
US

V. Phone/Fax

Practice location:
  • Phone: 607-288-2336
  • Fax: 607-304-5534
Mailing address:
  • Phone: 607-288-2336
  • Fax: 607-304-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: EMELINE MANDEVILLE
Title or Position: PRESIDENT
Credential: MIDWIFE
Phone: 607-351-0764