Provider Demographics
NPI:1770704215
Name:MOTHERHOOD EXPRESS
Entity type:Organization
Organization Name:MOTHERHOOD EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HANSER
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:859-746-2460
Mailing Address - Street 1:7000 HOUSTON RD
Mailing Address - Street 2:BUILDING 200 SUITE 19
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4873
Mailing Address - Country:US
Mailing Address - Phone:859-746-2460
Mailing Address - Fax:859-746-2238
Practice Address - Street 1:7000 HOUSTON RD
Practice Address - Street 2:BUILDING 200 SUITE 19
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4873
Practice Address - Country:US
Practice Address - Phone:859-746-2460
Practice Address - Fax:859-746-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90000159Medicaid
KY1284130001Medicare ID - Type Unspecified