Basic Information
| Provider Information | |||||||||
| NPI: | 1013087345 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LATINO FAMILY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3815 W FORT ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482161652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138417380 | ||||||||
| FaxNumber: | 3138413730 | ||||||||
| Practice Location | |||||||||
| Address1: | 3815 W FORT ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482161652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138417380 | ||||||||
| FaxNumber: | 3138413730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VILLARREAL | ||||||||
| AuthorizedOfficialFirstName: | ALICIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 3138417380 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD1600X | Y | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
No ID Information.