=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457537706
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY HEALTH AND BIRTH CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2008
-----------------------------------------------------
Last Update Date | 01/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 17TH ST NE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20002-7200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-398-5520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 17TH ST NE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20002-7200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-398-5520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL DIRECTOR
-----------------------------------------------------
Name | MRS. DIANA RACHEL JOLLES
-----------------------------------------------------
Credential | CNM, MS
-----------------------------------------------------
Telephone | 202-398-5520
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | HFD10-0001
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------