Healthcare Provider Details

I. General information

NPI: 1508314303
Provider Name (Legal Business Name): LTA COMPLETE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 NW 57TH CT
MIAMI FL
33126-3111
US

IV. Provider business mailing address

515 NW 57TH CT
MIAMI FL
33126-3111
US

V. Phone/Fax

Practice location:
  • Phone: 786-597-1023
  • Fax:
Mailing address:
  • Phone: 786-597-1023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: LISSETT TERRELONGE
Title or Position: CEO
Credential:
Phone: 786-597-1023