Provider Demographics
NPI:1780221069
Name:LATCH LADIES, LLC
Entity Type:Organization
Organization Name:LATCH LADIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:DAVIDSON
Authorized Official - Last Name:ZUKOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:817-456-1217
Mailing Address - Street 1:6416 LANSDALE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-1624
Mailing Address - Country:US
Mailing Address - Phone:817-456-1217
Mailing Address - Fax:
Practice Address - Street 1:6416 LANSDALE RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-1624
Practice Address - Country:US
Practice Address - Phone:817-456-1217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty