Provider Demographics
NPI:1578690863
Name:CONGRESO DE LATINOS UNIDOS, INC
Entity Type:Organization
Organization Name:CONGRESO DE LATINOS UNIDOS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY ASSURANCE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:215-763-8870
Mailing Address - Street 1:216 WEST SOMERSET STREET
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-3534
Mailing Address - Country:US
Mailing Address - Phone:215-763-8870
Mailing Address - Fax:215-291-9153
Practice Address - Street 1:216 WEST SOMERSET STREET
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-3534
Practice Address - Country:US
Practice Address - Phone:215-763-8870
Practice Address - Fax:215-291-9153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA850454101YA0400X
PA105810101YM0800X, 251S00000X
PA85045A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty