Provider Demographics
NPI:1558021394
Name:SUPPORTING OUR MOTHERS INITIATIVE
Entity Type:Organization
Organization Name:SUPPORTING OUR MOTHERS INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBENI
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:347-692-0488
Mailing Address - Street 1:17719 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-1929
Mailing Address - Country:US
Mailing Address - Phone:347-692-0488
Mailing Address - Fax:
Practice Address - Street 1:17719 120TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1929
Practice Address - Country:US
Practice Address - Phone:347-692-0488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty