Provider Demographics
NPI:1144450404
Name:POINTER, LATRIS D
Entity type:Individual
Prefix:MS
First Name:LATRIS
Middle Name:D
Last Name:POINTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11376 NORBORNE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2154
Mailing Address - Country:US
Mailing Address - Phone:313-682-7973
Mailing Address - Fax:
Practice Address - Street 1:11376 NORBORNE
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-2154
Practice Address - Country:US
Practice Address - Phone:313-682-7973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820297879385HR2050X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp