Provider Demographics
NPI:1336980556
Name:SIMMONS, LATOSHA
Entity type:Individual
Prefix:
First Name:LATOSHA
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4319 PHILADELPHIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-1928
Mailing Address - Country:US
Mailing Address - Phone:901-644-8814
Mailing Address - Fax:
Practice Address - Street 1:4319 PHILADELPHIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-1928
Practice Address - Country:US
Practice Address - Phone:190-164-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRS533003172A00000X
OH5718684251X00000X, 3747P1801X, 385HR2060X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
No251X00000XAgenciesSupports Brokerage
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child