MEDICARE: MOCHA ENTERPRISES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	163WL0100X	Lactation Consultant (Registered Nurse)
2	163WP1700X	Perinatal Registered Nurse
3	374J00000X	Doula
4	163W00000X	Registered Nurse

General Provider Information

NPI Number	:	1255289997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOCHA ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	1201 GROSSCUP AVE UNIT 822
Second Line	:
City	:	DUNBAR
State	:	WV
Zip	:	25064-4239
Country	:	US
Telephone Number	:	304-988-5905
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 GROSSCUP AVE UNIT 822
Second Line	:
City	:	DUNBAR
State	:	WV
Zip	:	25064-4239
Country	:	US
Telephone Number	:	304-988-5905
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CRYSTAL LOVETT
Credential	:	RN, IBCLC
Telephone Number	:	304-982-1495

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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Directions to “MOCHA ENTERPRISES LLC ” Practice Location

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