Provider Demographics
NPI:1023140274
Name:HOLY FAMILY PRENATAL CARE, LLC
Entity type:Organization
Organization Name:HOLY FAMILY PRENATAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-226-7414
Mailing Address - Street 1:359 FOREST AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4559
Mailing Address - Country:US
Mailing Address - Phone:937-228-4492
Mailing Address - Fax:937-228-4495
Practice Address - Street 1:359 FOREST AVE STE 202
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4559
Practice Address - Country:US
Practice Address - Phone:937-228-4492
Practice Address - Fax:937-228-4495
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIZABETH'S NEW LIFE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-12
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2414284Medicaid