Healthcare Provider Details

I. General information

NPI: 1578128815
Provider Name (Legal Business Name): LATHAM CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 MAIN ST
BREWSTER MA
02631-1716
US

IV. Provider business mailing address

1646 MAIN ST
BREWSTER MA
02631-1716
US

V. Phone/Fax

Practice location:
  • Phone: 774-353-9201
  • Fax:
Mailing address:
  • Phone: 774-353-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MEREDITH MORGAN
Title or Position: CONTROLLER
Credential:
Phone: 774-353-9201