Provider Demographics
NPI:1902431059
Name:HOMESTEAD NATURAL BIRTH CENTER, INC
Entity Type:Organization
Organization Name:HOMESTEAD NATURAL BIRTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:209-482-8682
Mailing Address - Street 1:1608 SUNRISE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4678
Mailing Address - Country:US
Mailing Address - Phone:209-622-0226
Mailing Address - Fax:209-622-0220
Practice Address - Street 1:1608 SUNRISE AVE STE A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4678
Practice Address - Country:US
Practice Address - Phone:209-622-0226
Practice Address - Fax:209-622-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4552190OtherARTICLES OF INCORPORATION