Provider Demographics
NPI:1639465339
Name:CENTRO CULTURAL CHICANO
Entity Type:Organization
Organization Name:CENTRO CULTURAL CHICANO
Other - Org Name:CENTRO, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-874-1412
Mailing Address - Street 1:1915 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1904
Mailing Address - Country:US
Mailing Address - Phone:612-874-1412
Mailing Address - Fax:612-874-8149
Practice Address - Street 1:1915 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1904
Practice Address - Country:US
Practice Address - Phone:612-874-1412
Practice Address - Fax:612-874-8149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management