Provider Demographics
NPI:1013774082
Name:LEVELED UP REENTRY
Entity Type:Organization
Organization Name:LEVELED UP REENTRY
Other - Org Name:LEVELED UP REENTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LATANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-878-8888
Mailing Address - Street 1:4227 S MERIDIAN STE D421
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3603
Mailing Address - Country:US
Mailing Address - Phone:253-878-8888
Mailing Address - Fax:
Practice Address - Street 1:7821 S PARK AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-5314
Practice Address - Country:US
Practice Address - Phone:253-878-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable