MEDICARE: LATINO TREATMENT CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720653827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LATINO TREATMENT CENTER

Provider Business Mailing Address
First Line	:	5413 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2222
Country	:	US
Telephone Number	:	773-465-1161
Fax Number	:

Provider Business Practice Location Address
First Line	:	5413 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2222
Country	:	US
Telephone Number	:	773-465-1161
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. ADRIANA TRINO
Credential	:	MA, CADC
Telephone Number	:	630-297-9707

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	09/09/2021

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Directions to “LATINO TREATMENT CENTER ” Practice Location

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