Provider Demographics
NPI:1790248854
Name:LACTATION HOME SUPPORT LLC
Entity Type:Organization
Organization Name:LACTATION HOME SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, IBCLC
Authorized Official - Phone:231-788-4767
Mailing Address - Street 1:1218 S FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-4814
Mailing Address - Country:US
Mailing Address - Phone:231-788-4767
Mailing Address - Fax:
Practice Address - Street 1:1218 S FOREST DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4814
Practice Address - Country:US
Practice Address - Phone:231-788-4767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-07
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty