Provider Demographics
NPI:1760298566
Name:BIRTHROOT COMMUNITY DOULA
Entity type:Organization
Organization Name:BIRTHROOT COMMUNITY DOULA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TICA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:NICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-449-6200
Mailing Address - Street 1:650 EAST AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16503-1535
Mailing Address - Country:US
Mailing Address - Phone:814-449-6200
Mailing Address - Fax:
Practice Address - Street 1:650 EAST AVE STE 106
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16503-1535
Practice Address - Country:US
Practice Address - Phone:814-449-6200
Practice Address - Fax:814-205-0755
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED NEIGHBORHOOD FACILITIES HEALTH CARE CORPORATION (UNFHCC)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty