01D2282468 CLIA NUMBER - MOUNTAIN HOME BIRTH & MIDWIFERY LLC

Laboratory Demographics

CLIA Number: 01D2282468

Facility Name: MOUNTAIN HOME BIRTH & MIDWIFERY LLC

Facility Address:
1949 GAULT AVENUE N #104
FORT PAYNE, AL
ZIP 35967
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Facility Phone Number: 256 330-7008

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1295321552

Taxonomy: 261QB0400X - Clinic/Center
A freestanding birth center is a health facility other than a hospital where childbirth is planned to occur away from the pregnant woman's residence, and that provides prenatal, labor and delivery, and postpartum care, as well as other ambulatory services for women and newborns.

CLIA Record

Field Name	Field Value
CLIA Number	01D2282468
LAB Type	Practitioner Other
Facility Name	MOUNTAIN HOME BIRTH & MIDWIFERY LLC
Street	1949 GAULT AVENUE N #104
City	FORT PAYNE
State	AL
ZIP	35967
Phone	256 330-7008
CertificateType	4
CertificateEffectiveDate	5/22/2023
CertificateExpirationDate	5/21/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024