Provider Demographics
NPI:1518782291
Name:DEEPLY ROOTED BIRTH & WELLNESS CARE
Entity type:Organization
Organization Name:DEEPLY ROOTED BIRTH & WELLNESS CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROFESSIONAL DOULA
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIEDAH
Authorized Official - Middle Name:SARAI-BAHT
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:CPD
Authorized Official - Phone:540-623-6584
Mailing Address - Street 1:2105 KAISER DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1334
Mailing Address - Country:US
Mailing Address - Phone:540-623-6584
Mailing Address - Fax:
Practice Address - Street 1:2105 KAISER DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-1334
Practice Address - Country:US
Practice Address - Phone:540-623-6584
Practice Address - Fax:651-855-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3001809276Medicaid