Provider Demographics
NPI:1548394679
Name:MOTHERS' MILK BANK OF NORTH TEXAS, INC.
Entity Type:Organization
Organization Name:MOTHERS' MILK BANK OF NORTH TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE BOARD OF DIRESTORS
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWARD-COMUENLLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-810-0071
Mailing Address - Street 1:1300 W LANCASTER AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-3410
Mailing Address - Country:US
Mailing Address - Phone:817-810-0071
Mailing Address - Fax:817-810-0087
Practice Address - Street 1:1300 W LANCASTER AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3410
Practice Address - Country:US
Practice Address - Phone:817-810-0071
Practice Address - Fax:817-810-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Single Specialty
Not Answered251K00000XAgenciesPublic Health or Welfare