Provider Demographics
NPI:1942458781
Name:MCHENRY CO. LATINO COALITION
Entity type:Organization
Organization Name:MCHENRY CO. LATINO COALITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:JORGE
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-206-0445
Mailing Address - Street 1:110 S JOHNSON ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3259
Mailing Address - Country:US
Mailing Address - Phone:815-206-0445
Mailing Address - Fax:815-206-1056
Practice Address - Street 1:110 S JOHNSON ST
Practice Address - Street 2:SUITE 212
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3259
Practice Address - Country:US
Practice Address - Phone:815-206-0445
Practice Address - Fax:815-206-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health