MEDICARE: CATHOLIC CHARITIES COMMUNITY SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	CSLG5979	AZ

General Provider Information

NPI Number	:	1134669229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHOLIC CHARITIES COMMUNITY SERVICES, INC

Provider Business Mailing Address
First Line	:	5151 N 19TH AVE STE G
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-3224
Country	:	US
Telephone Number	:	602-285-1999
Fax Number	:

Provider Business Practice Location Address
First Line	:	5119 N 19TH AVE STE G
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-3221
Country	:	US
Telephone Number	:	602-749-4405
Fax Number	:	602-749-4406

Authorized Official
Title or Position	:	VICE PRESIDENT OF PROGRAM OPERATION
Name	:	CARRIELYNN MASCARO
Credential	:
Telephone Number	:	602-525-3200

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	04/22/2026

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