Provider Demographics
NPI:1891742623
Name:BABY BELOVED, INC.
Entity Type:Organization
Organization Name:BABY BELOVED, INC.
Other - Org Name:PROFESSIONAL LACTATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WYSOCKI-EMERY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:616-485-6757
Mailing Address - Street 1:335 BRIDGE ST NW APT 1400
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5393
Mailing Address - Country:US
Mailing Address - Phone:616-485-6757
Mailing Address - Fax:616-333-7710
Practice Address - Street 1:233 FULTON ST E # 114E
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3200
Practice Address - Country:US
Practice Address - Phone:616-485-6757
Practice Address - Fax:616-333-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5563030001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4689115Medicaid
MI4689115Medicaid