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NPI Code Detail

MEDICARE: LATAVIA LACKING

MEDICARE: LATAVIA LACKING
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianTX

General Provider Information

NPI Number : 1780547489
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATAVIA LACKING
Provider Business Mailing Address
First Line : 350 FAIRWAY DR STE 101
Second Line :
City : DEERFIELD BEACH
State : FL
Zip : 33441-1834
Country : US
Telephone Number : 877-418-2978
Fax Number : 866-500-2186
Provider Business Practice Location Address
First Line : 700 MILAM ST STE 1300
Second Line :
City : HOUSTON
State : TX
Zip : 77002-2736
Country : US
Telephone Number : 877-418-2978
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

Similar Medicare Providers

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Directions to “ LATAVIA LACKING ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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