Provider Demographics
NPI:1386159051
Name:MOTHERS' MILK BANK OF THE WESTERN GREAT LAKES, INC.
Entity type:Organization
Organization Name:MOTHERS' MILK BANK OF THE WESTERN GREAT LAKES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-262-5134
Mailing Address - Street 1:1691 ELMHURST RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-6413
Mailing Address - Country:US
Mailing Address - Phone:847-262-5134
Mailing Address - Fax:
Practice Address - Street 1:1691 ELMHURST RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-6413
Practice Address - Country:US
Practice Address - Phone:847-262-5134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies