Healthcare Provider Details

I. General information

NPI: 1225684467
Provider Name (Legal Business Name): LATTER RAIN INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15824 BUENA VISTA DR
DERWOOD MD
20855-2658
US

IV. Provider business mailing address

15824 BUENA VISTA DR
DERWOOD MD
20855-2658
US

V. Phone/Fax

Practice location:
  • Phone: 240-643-7642
  • Fax: 301-847-0546
Mailing address:
  • Phone: 240-643-7642
  • Fax: 301-847-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. LILLIAN U EZEJI-OKOYE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 240-643-7642