Healthcare Provider Details

I. General information

NPI: 1346173283
Provider Name (Legal Business Name): LATICA HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2733 GLENDALE AVE STE A
TOLEDO OH
43614-2687
US

IV. Provider business mailing address

2733 GLENDALE AVE STE A
TOLEDO OH
43614-2687
US

V. Phone/Fax

Practice location:
  • Phone: 567-694-8825
  • Fax: 855-582-6544
Mailing address:
  • Phone: 567-694-8825
  • Fax: 855-582-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: