Provider Demographics
NPI:1801491543
Name:CENTRO TERAPEUTICO EQUILIBRIUM
Entity type:Organization
Organization Name:CENTRO TERAPEUTICO EQUILIBRIUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:LLANO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC, CAP
Authorized Official - Phone:305-999-5251
Mailing Address - Street 1:932 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3010
Mailing Address - Country:US
Mailing Address - Phone:305-999-5251
Mailing Address - Fax:
Practice Address - Street 1:932 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3010
Practice Address - Country:US
Practice Address - Phone:305-999-5251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility