NPIMap

Organization Active NPI

Lactation Village, LLC

  • In Home Supportive Care Agency
  • Detroit, MI
National Provider Identifier
1023405974
Registry record updated Apr 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
L-56572 Issued in MI
Legal business name
LACTATION VILLAGE, LLC
Practice address
14210 Glenwood St
Detroit, MI 48205-2829
Phone
(313) 920-4914
Fax
(248) 809-9888
NPI assigned
Apr 17, 2015
Last updated
Apr 17, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Stacy Davis, IBCLCNPI 1275938391
Title
Executive Director/Ibclc
Phone
(313) 920-4914

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X L-56572 MI Primary

Addresses

Primary practice location

14210 Glenwood St
Detroit, MI 48205-2829

Mailing address

14210 Glenwood St
Detroit, MI 48205-2829
Phone (313) 920-4914

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429228800000",
    "number": "1023405974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14210 GLENWOOD ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482052829",
            "telephone_number": "313-920-4914",
            "fax_number": "248-809-9888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14210 GLENWOOD ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482052829",
            "telephone_number": "313-920-4914",
            "fax_number": "248-809-9888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LACTATION VILLAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-17",
        "last_updated": "2015-04-17",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/IBCLC",
        "authorized_official_telephone_number": "313-920-4914",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "IBCLC"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "MI",
            "license": "L-56572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.