Provider Demographics
NPI:1679380521
Name:CROWE, LATISHA (RN, EFM, ACLS)
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:
Last Name:CROWE
Suffix:
Gender:F
Credentials:RN, EFM, ACLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4396 AMMON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2804
Mailing Address - Country:US
Mailing Address - Phone:216-258-5937
Mailing Address - Fax:
Practice Address - Street 1:4396 AMMON RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44143-2804
Practice Address - Country:US
Practice Address - Phone:216-258-5937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH491034251E00000X, 3104A0625X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness