Provider Demographics
NPI:1598982688
Name:MOM-4-A-DAY
Entity Type:Organization
Organization Name:MOM-4-A-DAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-839-8985
Mailing Address - Street 1:304 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-1147
Mailing Address - Country:US
Mailing Address - Phone:985-839-8985
Mailing Address - Fax:985-839-8986
Practice Address - Street 1:304 11TH AVE
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-1147
Practice Address - Country:US
Practice Address - Phone:985-839-8985
Practice Address - Fax:985-839-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12260251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1643122Medicaid