=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952086993
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELLE GROVE BIRTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2023
-----------------------------------------------------
Last Update Date | 06/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 W 10TH ST STE A
-----------------------------------------------------
City | FRONT ROYAL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22630-2812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-622-7069
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 LOST ACRES LN
-----------------------------------------------------
City | AMISSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20106-4146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-622-7069
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MIDWIFE
-----------------------------------------------------
Name | JENNIFER DAVIDSON
-----------------------------------------------------
Credential | CPM, LM
-----------------------------------------------------
Telephone | 540-622-7069
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QB0400X
-----------------------------------------------------
Taxonomy Name | Birthing Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------