Provider Demographics
NPI:1831868215
Name:LATINO TREATMENT CENTER
Entity type:Organization
Organization Name:LATINO TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-695-9155
Mailing Address - Street 1:245 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-3739
Mailing Address - Country:US
Mailing Address - Phone:630-293-9707
Mailing Address - Fax:
Practice Address - Street 1:245 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-3739
Practice Address - Country:US
Practice Address - Phone:630-293-9707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0-969-0003-AMedicaid