Provider Demographics
NPI:1821339136
Name:MOMMY'S OWN
Entity Type:Organization
Organization Name:MOMMY'S OWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-362-6899
Mailing Address - Street 1:1107 E PISA ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-362-6899
Mailing Address - Fax:
Practice Address - Street 1:1107 E PISA ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7888
Practice Address - Country:US
Practice Address - Phone:208-362-6899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies