Provider Demographics
NPI:1306265954
Name:LAT INTENSIVE OUTPATIENT PROGRAMS INC
Entity type:Organization
Organization Name:LAT INTENSIVE OUTPATIENT PROGRAMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-572-7000
Mailing Address - Street 1:4551 GLENCOE AVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292
Mailing Address - Country:US
Mailing Address - Phone:310-572-7000
Mailing Address - Fax:310-943-2293
Practice Address - Street 1:4551 GLENCOE AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292
Practice Address - Country:US
Practice Address - Phone:310-572-7000
Practice Address - Fax:310-943-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health