Provider Demographics
NPI:1407129190
Name:LATTER GLORY HOUSE
Entity Type:Organization
Organization Name:LATTER GLORY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUSEYE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINDEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-259-7389
Mailing Address - Street 1:9704 GEORGE WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5811
Mailing Address - Country:US
Mailing Address - Phone:972-259-7389
Mailing Address - Fax:
Practice Address - Street 1:9704 GEORGE WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5811
Practice Address - Country:US
Practice Address - Phone:972-259-7389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-11
Last Update Date:2012-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities