Provider Demographics
NPI:1235968934
Name:DEEP WATER LATCH, LLC
Entity type:Organization
Organization Name:DEEP WATER LATCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PORSHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-794-9994
Mailing Address - Street 1:115 NAVARRE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2367
Mailing Address - Country:US
Mailing Address - Phone:617-794-9994
Mailing Address - Fax:
Practice Address - Street 1:115 NAVARRE ST APT 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02136-2367
Practice Address - Country:US
Practice Address - Phone:617-794-9994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty