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General NPI Number Information
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NPI Number | 1023793247
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Entity Type | Organization
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Legal Business Name | THE EXPERIENCE BY LATANYA
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 7969 ATTWATER ST
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City | HOUSTON
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State | TX
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Zip | 77028-4616
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Country | US
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Telephone | 832-545-4514
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Fax |
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Provider Business Mailing Address
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Address Line | 1802 WOODED ACRES DR
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City | HUMBLE
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State | TX
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Zip | 77396-2991
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Country | US
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Telephone | 832-572-3736
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Fax |
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Authorized Official
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Title or Position | CEO / DIRECTOR
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Name | LATANYA SAM
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Credential |
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Telephone | 832-545-4514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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