Provider Demographics
NPI:1023793247
Name:THE EXPERIENCE BY LATANYA
Entity type:Organization
Organization Name:THE EXPERIENCE BY LATANYA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO / DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-545-4514
Mailing Address - Street 1:1802 WOODED ACRES DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-2991
Mailing Address - Country:US
Mailing Address - Phone:832-572-3736
Mailing Address - Fax:
Practice Address - Street 1:7969 ATTWATER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028-4616
Practice Address - Country:US
Practice Address - Phone:832-545-4514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities