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General NPI Number Information
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NPI Number | 1932226529
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Entity Type | Organization
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Legal Business Name | MOM-4-A-DAY
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 304 11TH AVE
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City | FRANKLINTON
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State | LA
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Zip | 70438-1147
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Country | US
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Telephone | 985-839-8985
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Fax | 985-839-8986
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Provider Business Mailing Address
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Address Line | 304 11TH AVE
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City | FRANKLINTON
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State | LA
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Zip | 70438-1147
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Country | US
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Telephone | 985-839-8985
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Fax | 985-839-8986
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Authorized Official
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Title or Position | ADMINISTRAROR
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Name | MRS. MARIA JACOBS
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Credential |
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Telephone | 985-839-0089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | PCA 12260
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License Number State | LA
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