MEDICARE: THE NATURAL MOMMA ME INITIATIVE

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1184962367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE NATURAL MOMMA ME INITIATIVE

Provider Business Mailing Address
First Line	:	420 E FERRY ST # 2
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3819
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 E FERRY ST # 2
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3819
Country	:	US
Telephone Number	:	313-354-0707
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. AISHA YOUNG
Credential	:
Telephone Number	:	313-354-0707

Provider Enumeration Date	:	01/23/2013
Last Update Date	:	01/23/2013

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Directions to “THE NATURAL MOMMA ME INITIATIVE ” Practice Location

Language	Start Address	Practice Location

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