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General NPI Number Information
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NPI Number | 1750420600
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Entity Type | Organization
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Legal Business Name | LATITUDE, LLC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 167 SAUNIER ST
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City | LEXINGTON
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State | KY
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Zip | 40507-1251
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Country | US
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Telephone | 859-806-0195
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Fax | 859-233-7927
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Provider Business Mailing Address
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Address Line | 167 SAUNIER ST
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City | LEXINGTON
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State | KY
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Zip | 40507-1251
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Country | US
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Telephone | 859-806-0195
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Fax | 859-233-7927
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Authorized Official
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Title or Position | MEDICAID DIVISION DIRECTOR
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Name | MRS. CRYSTAL BADER
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Credential |
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Telephone | 859-806-0195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | KY
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