Provider Demographics
NPI:1053047456
Name:LA RAZA SERVICES INC
Entity Type:Organization
Organization Name:LA RAZA SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BEHAVIORAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:BELEN
Authorized Official - Last Name:VIZOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-953-5910
Mailing Address - Street 1:3131 W 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2203
Mailing Address - Country:US
Mailing Address - Phone:303-458-5851
Mailing Address - Fax:
Practice Address - Street 1:3131 W 14TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2203
Practice Address - Country:US
Practice Address - Phone:303-458-5851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA RAZA SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000167581Medicaid