Healthcare Provider Details

I. General information

NPI: 1962168278
Provider Name (Legal Business Name): MOM VILLAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 HARFORD RD STE 1
BALTIMORE MD
21214-2964
US

IV. Provider business mailing address

4910 HARFORD RD STE 1
BALTIMORE MD
21214-2964
US

V. Phone/Fax

Practice location:
  • Phone: 443-449-7335
  • Fax:
Mailing address:
  • Phone: 410-205-6603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHERITTA N GRIER
Title or Position: CEO
Credential:
Phone: 410-205-6603