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General NPI Number Information
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NPI Number | 1366865362
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Entity Type | Organization
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Legal Business Name | EDENS GARDEN BIRTH
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Dates
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Enumeration Date | 01/27/2014
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 5255 OLD COLUMBIA RD
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City | GOOCHLAND
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State | VA
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Zip | 23063-2717
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Country | US
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Telephone | 804-869-1225
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Fax |
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Provider Business Mailing Address
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Address Line | 5255 OLD COLUMBIA RD
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City | GOOCHLAND
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State | VA
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Zip | 23063-2717
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Country | US
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Telephone | 804-869-1225
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AMY BLAKE ROLLOGAS
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Credential |
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Telephone | 804-869-1225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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