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NPI Code Detail

MEDICARE: CATHOLIC CHARITIES OF THE DIOCESE OF GREEN BAY INC

MEDICARE: CATHOLIC CHARITIES OF THE DIOCESE OF GREEN BAY 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376769117
Entity Type Code : Organization
Provider Name (Legal Business Name) : CATHOLIC CHARITIES OF THE DIOCESE OF GREEN BAY INC
Provider Business Mailing Address
First Line : PO BOX 23825
Second Line :
City : GREEN BAY
State : WI
Zip : 54305-3825
Country : US
Telephone Number : 920-272-8234
Fax Number : 920-437-4067
Provider Business Practice Location Address
First Line : 1825 RIVERSIDE DRIVE
Second Line :
City : GREEN BAY
State : WI
Zip : 54305-3825
Country : US
Telephone Number : 920-272-8234
Fax Number : 920-437-4067
Authorized Official
Title or Position : DIRECTOR OF CATHOLIC CHARITIES
Name : KARMEN LEMKE
Credential :
Telephone Number : 920-272-8226
Provider Enumeration Date : 04/18/2007
Last Update Date : 03/19/2024

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Directions to “CATHOLIC CHARITIES OF THE DIOCESE OF GREEN BAY INC ” Practice Location

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