Provider Demographics
NPI:1811406564
Name:ROUSE, LATONYA
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:ROUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5214 VIA HACIENDA CIR APT 206
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-2187
Mailing Address - Country:US
Mailing Address - Phone:1321-437-2673
Mailing Address - Fax:132-143-7267
Practice Address - Street 1:5214 VIA HACIENDA
Practice Address - Street 2:206
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839
Practice Address - Country:US
Practice Address - Phone:321-437-2673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities