Healthcare Provider Details

I. General information

NPI: 1477364420
Provider Name (Legal Business Name): MILK OF MOTHERS (M.O.M.), LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1784 1500 RD
DELTA CO
81416-8806
US

IV. Provider business mailing address

1784 1500 RD
DELTA CO
81416-8806
US

V. Phone/Fax

Practice location:
  • Phone: 970-231-9459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JODI HYATT
Title or Position: LACTATION CONSULTANT
Credential: RN
Phone: 970-231-9459