Provider Demographics
NPI:1487068391
Name:LATTER RAIN ASSOCIATES
Entity type:Organization
Organization Name:LATTER RAIN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:BERNICE
Authorized Official - Last Name:POORE
Authorized Official - Suffix:
Authorized Official - Credentials:MED, PVR
Authorized Official - Phone:330-284-8929
Mailing Address - Street 1:PO BOX 20571
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44701-0571
Mailing Address - Country:US
Mailing Address - Phone:330-456-8830
Mailing Address - Fax:330-453-9377
Practice Address - Street 1:1631 SHERRICK RD SE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-3536
Practice Address - Country:US
Practice Address - Phone:330-456-8830
Practice Address - Fax:330-453-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-7094310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness