Healthcare Provider Details

I. General information

NPI: 1396350880
Provider Name (Legal Business Name): LATASHA RENE HORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 10TH ST SE
DECATUR AL
35601-4421
US

IV. Provider business mailing address

1104 DANVILLE RD SW
DECATUR AL
35601-2951
US

V. Phone/Fax

Practice location:
  • Phone: 256-686-4109
  • Fax:
Mailing address:
  • Phone: 678-670-0062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: