Provider Demographics
NPI:1619394822
Name:MOMMYS LOVE BUG LLC
Entity Type:Organization
Organization Name:MOMMYS LOVE BUG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:DESIREE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-894-6462
Mailing Address - Street 1:24853 ARDEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2211
Mailing Address - Country:US
Mailing Address - Phone:248-894-6462
Mailing Address - Fax:866-594-6994
Practice Address - Street 1:24853 ARDEN PARK DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2211
Practice Address - Country:US
Practice Address - Phone:248-894-6462
Practice Address - Fax:866-594-6994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty