Individual
LATONYA POLK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
205 E US HIGHWAY 80, WHITE OAK, TX 75693-2103
(903) 297-4959
(903) 297-4999
Mailing address
PO BOX 8664, LONGVIEW, TX 75607-8664
(903) 315-8302
(903) 297-4959
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
310400000X
Assisted Living Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
12/06/2006
Last updated
07/24/2019
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