Healthcare Provider Details

I. General information

NPI: 1720406366
Provider Name (Legal Business Name): FAMILY TREES BIRTH PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2481 NEW HOLLAND PIKE
LANCASTER PA
17601-5953
US

IV. Provider business mailing address

2481 NEW HOLLAND PIKE
LANCASTER PA
17601-5953
US

V. Phone/Fax

Practice location:
  • Phone: 717-661-7887
  • Fax:
Mailing address:
  • Phone: 717-661-7887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. WENDY LOREE SHIFFER
Title or Position: OWNER/DIRECTOR
Credential: CD(DONA), LCCE, BS
Phone: 717-661-7887