Healthcare Provider Details

I. General information

NPI: 1285693630
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE DIOCESE OF PEORIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 S MORRIS AVE
BLOOMINGTON IL
61701-4884
US

IV. Provider business mailing address

2900 W HEADING AVE
WEST PEORIA IL
61604-4868
US

V. Phone/Fax

Practice location:
  • Phone: 309-636-8041
  • Fax: 309-636-8097
Mailing address:
  • Phone: 309-636-8012
  • Fax: 309-674-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. PEGGY A. ARIZZI
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW, LCSW
Phone: 309-636-8012