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General NPI Number Information
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NPI Number | 1720653827
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Entity Type | Organization
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Legal Business Name | LATINO TREATMENT CENTER
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 5413 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2222
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Country | US
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Telephone | 773-465-1161
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Fax |
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Provider Business Mailing Address
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Address Line | 5413 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2222
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Country | US
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Telephone | 773-465-1161
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ADRIANA TRINO
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Credential | MA, CADC
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Telephone | 630-297-9707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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