Healthcare Provider Details

I. General information

NPI: 1881071876
Provider Name (Legal Business Name): HOMEBIRTH WITH LOVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SCENIC DR
SUFFERN NY
10901-1708
US

IV. Provider business mailing address

3 SCENIC DR
SUFFERN NY
10901
US

V. Phone/Fax

Practice location:
  • Phone: 845-323-1718
  • Fax: 360-351-9177
Mailing address:
  • Phone: 845-641-5058
  • Fax: 360-351-9177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License NumberFOO977
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02383017
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: MRS. LEAH MARINELLI
Title or Position: OWNER OPERATOR
Credential: CNM NP
Phone: 845-641-5058