Provider Demographics
NPI:1134973829
Name:LATITIANA'S HEALTHCARE GROUP, LLC
Entity type:Organization
Organization Name:LATITIANA'S HEALTHCARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMELLA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-898-6994
Mailing Address - Street 1:9700 MACKENZIE RD
Mailing Address - Street 2:SUITE 225 B
Mailing Address - City:AFFTON
Mailing Address - State:MO
Mailing Address - Zip Code:63123
Mailing Address - Country:US
Mailing Address - Phone:636-898-6994
Mailing Address - Fax:
Practice Address - Street 1:9700 MACKENZIE RD
Practice Address - Street 2:SUITE 225 B
Practice Address - City:AFFTON
Practice Address - State:MO
Practice Address - Zip Code:63123
Practice Address - Country:US
Practice Address - Phone:636-898-6994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty