Provider Demographics
NPI:1598805335
Name:LATIN AMERICAN YOUTH CENTER
Entity Type:Organization
Organization Name:LATIN AMERICAN YOUTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-319-8642
Mailing Address - Street 1:1419 COLUMBIA RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4705
Mailing Address - Country:US
Mailing Address - Phone:202-319-2225
Mailing Address - Fax:202-462-5696
Practice Address - Street 1:1419 COLUMBIA RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4705
Practice Address - Country:US
Practice Address - Phone:202-319-2225
Practice Address - Fax:202-462-5696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC036392800261QM0801X
DC102600A-Y-027261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036392800Medicaid
DC043722400Medicaid