Healthcare Provider Details

I. General information

NPI: 1952387219
Provider Name (Legal Business Name): CATHOLIC CHARITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S STATE ST
BEARDSTOWN IL
62618-1217
US

IV. Provider business mailing address

111 S STATE ST
BEARDSTOWN IL
62618-1217
US

V. Phone/Fax

Practice location:
  • Phone: 217-323-5264
  • Fax: 217-323-4680
Mailing address:
  • Phone: 217-323-5264
  • Fax: 217-323-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. STEVEN ROACH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 217-523-9201