Provider Demographics
NPI:1720653827
Name:LATINO TREATMENT CENTER
Entity Type:Organization
Organization Name:LATINO TREATMENT CENTER
Other - Org Name:LATINO TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRINO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CADC
Authorized Official - Phone:630-297-9707
Mailing Address - Street 1:5413 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2222
Mailing Address - Country:US
Mailing Address - Phone:773-465-1161
Mailing Address - Fax:
Practice Address - Street 1:5413 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2222
Practice Address - Country:US
Practice Address - Phone:773-465-1161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0-0969-0006-AMedicaid