Active NPI
Latisha Clark
- Developmentally Disabled Services Day Training Agency
- Indianapolis, IN
National Provider Identifier
1932714318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmentally Disabled Services Day Training Agency
- Practice address
- 8109 Blackgum CT
Indianapolis, IN 46236-8260 - Phone
- (317) 658-5177
- NPI assigned
- Sep 11, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmentally Disabled Services Day Training Agency | 251C00000X | Primary |
Addresses
Primary practice location
8109 Blackgum CT
Indianapolis, IN 46236-8260
Mailing address
8109 Blackgum CT
Indianapolis, IN 46236-8260
Phone (317) 658-5177
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00000000 | Other | IN | LATISHA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656547200000",
"number": "1932714318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8109 BLACKGUM CT",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462368260",
"telephone_number": "317-658-5177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8109 BLACKGUM CT",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462368260",
"telephone_number": "317-658-5177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LATISHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-11",
"last_updated": "2022-06-30",
"certification_date": "2022-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "251C00000X",
"taxonomy_group": "",
"desc": "Day Training, Developmentally Disabled Services",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LATISHA",
"identifier": "00000000",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.