| Organization Name: | LAKE CITY BIRTH, LLC |
| NPI Number: | 1285040097 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANGELA FENNELL (OWNER) |
| Mailing Address: | 5113 256th St O Brien |
| State: | FL US |
| Postal Code: | 320714435 |
| Phone Number: | 3862990698 |
| Fax Number: | 8008535087 |
| NPI Enumeration Date: | 07/01/2014 |
| NPI Last Update Date: | 07/01/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QB0400X |
| License Number: | MW 294 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Birthing |
| Taxonomy Definition: | |