Basic Information
| Provider Information | |||||||||
| NPI: | 1346575305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EL FUTURO, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 CHAPEL HILL RD STE 23 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277071186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196887101 | ||||||||
| FaxNumber: | 9193382729 | ||||||||
| Practice Location | |||||||||
| Address1: | 2020 CHAPEL HILL RD. | ||||||||
| Address2: | STE 23 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196887101 | ||||||||
| FaxNumber: | 9196887102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2009 | ||||||||
| LastUpdateDate: | 01/14/2019 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | LUCAS | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9193381939 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EL FUTURO, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 6005688 | 05 | NC | MEDICAID |