Provider Demographics
NPI:1033271929
Name:MOTHERS' MILK BANK
Entity Type:Organization
Organization Name:MOTHERS' MILK BANK
Other - Org Name:PRESBYTERIAN ST. LUKE'S MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LARAINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:303-869-1888
Mailing Address - Street 1:1719 E 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1235
Mailing Address - Country:US
Mailing Address - Phone:303-869-1888
Mailing Address - Fax:303-839-7336
Practice Address - Street 1:1719 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1235
Practice Address - Country:US
Practice Address - Phone:303-869-1888
Practice Address - Fax:303-839-7336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY MOUNTAIN CHILDREN'S HEALTH FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-15
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08003378Medicaid