MEDICARE: MEADOW LACTATION CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1730048299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEADOW LACTATION CARE LLC

Provider Business Mailing Address
First Line	:	5512 DENNIS AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-4504
Country	:	US
Telephone Number	:	940-206-6136
Fax Number	:

Provider Business Practice Location Address
First Line	:	5512 DENNIS AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-4504
Country	:	US
Telephone Number	:	940-206-6136
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CATHARINE S DEMORE
Credential	:	IBCLC
Telephone Number	:	940-206-6136

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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