Provider Demographics
NPI:1144702036
Name:LABOR OF LOVE MIDWIFERY AND WOMEN HEALTH SERVICES LLC
Entity type:Organization
Organization Name:LABOR OF LOVE MIDWIFERY AND WOMEN HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOWRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:618-553-8369
Mailing Address - Street 1:12188 N 920TH ST
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-4314
Mailing Address - Country:US
Mailing Address - Phone:618-553-8369
Mailing Address - Fax:
Practice Address - Street 1:309 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-2722
Practice Address - Country:US
Practice Address - Phone:618-553-8369
Practice Address - Fax:959-666-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010085176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL343561312001Medicaid