=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629845979
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTRICATE WORKS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2023
-----------------------------------------------------
Last Update Date | 12/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 299 E 54TH ST APT 2
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11203-4650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-433-6780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 299 E 54TH ST APT 2
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11203-4650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-433-6780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOULA
-----------------------------------------------------
Name | ALYSIA JOY POWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-259-9819
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------