Healthcare Provider Details

I. General information

NPI: 1356939656
Provider Name (Legal Business Name): LATIN ENRICHMENT ORGANIZATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 FOREST ST
HARTFORD CT
06105-3204
US

IV. Provider business mailing address

PO BOX 380322
EAST HARTFORD CT
06138-0322
US

V. Phone/Fax

Practice location:
  • Phone: 860-249-0975
  • Fax:
Mailing address:
  • Phone: 860-249-0975
  • Fax: 860-249-0975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLOS MARRERO
Title or Position: DIRECTOR
Credential: MSW, ACSW
Phone: 860-249-0975