Healthcare Provider Details

I. General information

NPI: 1316517873
Provider Name (Legal Business Name): LATOYA DEVAUGHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 INDIAN WOOD CIR STE 200
MAUMEE OH
43537-4055
US

IV. Provider business mailing address

1715 INDIAN WOOD CIR STE 200
MAUMEE OH
43537-4055
US

V. Phone/Fax

Practice location:
  • Phone: 419-917-6243
  • Fax:
Mailing address:
  • Phone: 419-917-6243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: