Healthcare Provider Details

I. General information

NPI: 1386813343
Provider Name (Legal Business Name): LATINO TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 S GROVE AVE
ELGIN IL
60120-6404
US

IV. Provider business mailing address

54 S GROVE AVE
ELGIN IL
60120-6404
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-9155
  • Fax:
Mailing address:
  • Phone: 847-695-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberA-0969-0001-A
License Number StateIL

VIII. Authorized Official

Name: MS. ADRIANA C PUJALS
Title or Position: ASSISTENT DIRECTOR
Credential: MA, CADC
Phone: 847-695-9155