Provider Demographics
NPI:1023021441
Name:EL LUCERO - A BILINGUAL LIFE SKILLS CENTER
Entity Type:Organization
Organization Name:EL LUCERO - A BILINGUAL LIFE SKILLS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR-BILINGUAL INSTRUCTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:AMALYA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC
Authorized Official - Phone:540-372-7211
Mailing Address - Street 1:PO BOX 42178
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-2178
Mailing Address - Country:US
Mailing Address - Phone:540-372-7211
Mailing Address - Fax:540-372-7233
Practice Address - Street 1:106 CAMBRIDGE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-1952
Practice Address - Country:US
Practice Address - Phone:540-372-7211
Practice Address - Fax:540-372-7223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102137170300000X, 252Y00000X, 276400000X, 302F00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No170300000XOther Service ProvidersGenetic Counselor, MSGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No276400000XHospital UnitsRehabilitation, Substance Use Disorder UnitGroup - Multi-Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Multi-Specialty