MEDICARE: DARITTA MARIE LATHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	385HR2050X	Respite Care Camp
3	101Y00000X	Counselor
4	251S00000X	Community/Behavioral Health Agency
5	251B00000X	Case Management Agency
6	261QD1600X	Developmental Disabilities Clinic/Center
7	320700000X	Physical Disabilities Residential Treatment Facility
8	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility
9	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
10	385H00000X	Respite Care
11	385HR2055X	Child Mental Illness Respite Care
12	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1770334245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARITTA MARIE LATHAM

Provider Business Mailing Address
First Line	:	30799 PINETREE RD
Second Line	:
City	:	PEPPER PIKE
State	:	OH
Zip	:	44124-5903
Country	:	US
Telephone Number	:	440-657-0556
Fax Number	:	216-274-9696

Provider Business Practice Location Address
First Line	:	8121 GRAND DIVISION AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-1246
Country	:	US
Telephone Number	:	440-657-0556
Fax Number	:	216-274-9696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2024
Last Update Date	:	04/24/2026

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Directions to “ DARITTA MARIE LATHAM ” Practice Location

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