Provider Demographics
NPI:1467768812
Name:LATHAM CENTERS, INC.
Entity Type:Organization
Organization Name:LATHAM CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-896-5776
Mailing Address - Street 1:1646 ROUTE 6A
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-1716
Mailing Address - Country:US
Mailing Address - Phone:508-896-5776
Mailing Address - Fax:508-896-6782
Practice Address - Street 1:1646 ROUTE 6A
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-1716
Practice Address - Country:US
Practice Address - Phone:508-896-5776
Practice Address - Fax:508-896-6782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1476466320600000X
MA1476468320600000X
MA1476467320600000X
MA9012334320900000X
MA9012336322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILA 94288Medicaid