Provider Demographics
NPI:1932845989
Name:MELINATED MOMS, LLC
Entity Type:Organization
Organization Name:MELINATED MOMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JATESHA
Authorized Official - Middle Name:PORTIA-ARLEE
Authorized Official - Last Name:MADDEN-WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:716-984-9672
Mailing Address - Street 1:142 LAFAYETTE STREET
Mailing Address - Street 2:3RD SPACE
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105
Mailing Address - Country:US
Mailing Address - Phone:716-984-9672
Mailing Address - Fax:
Practice Address - Street 1:142 LAFAYETTE STREET
Practice Address - Street 2:3RD SPACE
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105
Practice Address - Country:US
Practice Address - Phone:716-984-9672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No207VC0300XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyComplex Family PlanningGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty