Provider Demographics
NPI:1043093396
Name:LATCHED LLC
Entity type:Organization
Organization Name:LATCHED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPH, APRN,WHNP
Authorized Official - Phone:386-747-5511
Mailing Address - Street 1:17000 EL CAMINO REAL STE 204A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2636
Mailing Address - Country:US
Mailing Address - Phone:832-284-4328
Mailing Address - Fax:
Practice Address - Street 1:17000 EL CAMINO REAL STE 204A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2636
Practice Address - Country:US
Practice Address - Phone:832-284-4328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center