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General NPI Number Information
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NPI Number | 1245997261
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Entity Type | Organization
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Legal Business Name | TRILLIUM HOUSE LLC
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Dates
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Enumeration Date | 11/24/2021
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Last Update Date | 11/24/2021
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Provider Practice Location Address
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Address Line | 3105 FORT AVE
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City | LYNCHBURG
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State | VA
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Zip | 24501-3809
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Country | US
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Telephone | 434-384-9602
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Fax | 434-384-9603
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Provider Business Mailing Address
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Address Line | 3105 FORT AVE
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City | LYNCHBURG
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State | VA
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Zip | 24501-3809
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Country | US
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Telephone | 434-384-9602
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Fax | 434-384-9603
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Authorized Official
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Title or Position | LICENSED MIDWIFE
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Name | LESLIE M PAYNE
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Credential | CPM
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Telephone | 434-384-9602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State |
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