Provider Demographics
NPI:1750420600
Name:LATITUDE, LLC
Entity type:Organization
Organization Name:LATITUDE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID DIVISION DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-806-0195
Mailing Address - Street 1:167 SAUNIER ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-1251
Mailing Address - Country:US
Mailing Address - Phone:859-806-0195
Mailing Address - Fax:859-233-7927
Practice Address - Street 1:167 SAUNIER ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-1251
Practice Address - Country:US
Practice Address - Phone:859-806-0195
Practice Address - Fax:859-233-7927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services