Provider Demographics
NPI:1417428756
Name:MOTHER'S MILK LLC
Entity Type:Organization
Organization Name:MOTHER'S MILK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:KEHAU
Authorized Official - Last Name:KEALOHA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:808-887-6659
Mailing Address - Street 1:PO BOX 2625
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-2625
Mailing Address - Country:US
Mailing Address - Phone:808-887-6659
Mailing Address - Fax:
Practice Address - Street 1:64-778 PAELIALANUI STREET
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-2625
Practice Address - Country:US
Practice Address - Phone:808-887-6659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HISMXPR0032688Medicaid