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General NPI Number Information
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NPI Number | 1376969097
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Entity Type | Organization
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Legal Business Name | HOME SWEET HOME BIRTH MIDWIFERY LLC
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 03/06/2014
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Provider Practice Location Address
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Address Line | 1241 MAMARONECK AVE
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City | WHITE PLAINS
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State | NY
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Zip | 10605-5201
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Country | US
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Telephone | 914-421-1515
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Fax | 914-421-1501
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Provider Business Mailing Address
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Address Line | 1241 MAMARONECK AVE
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City | WHITE PLAINS
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State | NY
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Zip | 10605-5201
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Country | US
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Telephone | 914-421-1515
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Fax | 914-421-1501
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. LISA HELEN GUSSACK
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Credential | CNM
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Telephone | 914-421-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | F000493
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | F001509-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | F000109
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License Number State | NY
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