Provider Demographics
NPI:1043524267
Name:LUIS ALVAREZ LLC
Entity Type:Organization
Organization Name:LUIS ALVAREZ LLC
Other - Org Name:WESTERN MOUNTAIN YOUTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:719-852-9697
Mailing Address - Street 1:922 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTE VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81144-1443
Mailing Address - Country:US
Mailing Address - Phone:719-852-9697
Mailing Address - Fax:
Practice Address - Street 1:922 2ND AVE
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1443
Practice Address - Country:US
Practice Address - Phone:719-852-9697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1593695320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56481322Medicaid