Provider Demographics
NPI:1730882259
Name:MY VILLAGE LLC
Entity type:Organization
Organization Name:MY VILLAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDELINDE
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:540-526-6180
Mailing Address - Street 1:7201 MOUNT CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-7745
Mailing Address - Country:US
Mailing Address - Phone:540-526-6180
Mailing Address - Fax:
Practice Address - Street 1:3142 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3727
Practice Address - Country:US
Practice Address - Phone:540-200-8662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY VILLAGE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty