Provider Demographics
NPI:1922456144
Name:NUEVO AMANECER LATINO CHILDREN'S SERVICES
Entity Type:Organization
Organization Name:NUEVO AMANECER LATINO CHILDREN'S SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-750-9951
Mailing Address - Street 1:5400 POMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1717
Mailing Address - Country:US
Mailing Address - Phone:323-720-9951
Mailing Address - Fax:323-720-9953
Practice Address - Street 1:2025 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-3913
Practice Address - Country:US
Practice Address - Phone:909-475-8793
Practice Address - Fax:909-886-4958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366408237253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency