Provider Demographics
NPI:1922294495
Name:LATHAM PLACE, LLC
Entity Type:Organization
Organization Name:LATHAM PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GOVERNOR
Authorized Official - Prefix:MR
Authorized Official - First Name:R
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:MADEL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:507-835-2800
Mailing Address - Street 1:105 8TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-1907
Mailing Address - Country:US
Mailing Address - Phone:507-835-2800
Mailing Address - Fax:507-833-1391
Practice Address - Street 1:105 8TH ST NW
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-1907
Practice Address - Country:US
Practice Address - Phone:507-835-2800
Practice Address - Fax:507-833-1391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN336985310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility