Provider Demographics
NPI:1124208525
Name:HISPANIC LATINO COMMUNITY RESOURCE CENTER
Entity Type:Organization
Organization Name:HISPANIC LATINO COMMUNITY RESOURCE CENTER
Other - Org Name:MI CASA SU CASA CENTRO DE RECURSOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LA PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-536-5091
Mailing Address - Street 1:6030 ALBEMARLE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-3787
Mailing Address - Country:US
Mailing Address - Phone:704-536-5091
Mailing Address - Fax:704-536-9876
Practice Address - Street 1:6030 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-3787
Practice Address - Country:US
Practice Address - Phone:704-536-5091
Practice Address - Fax:704-536-9876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health