Healthcare Provider Details

I. General information

NPI: 1669583001
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE ARCHDIOCESE OF CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date: 05/12/2023
Reactivation Date: 06/02/2023

III. Provider practice location address

730 N WABASH AVE COURTYARD BUILDING
CHICAGO IL
60611-2514
US

IV. Provider business mailing address

730 N WABASH AVE COURTYARD BUILDING
CHICAGO IL
60611-2514
US

V. Phone/Fax

Practice location:
  • Phone: 312-573-8005
  • Fax: 312-573-7719
Mailing address:
  • Phone: 312-573-8005
  • Fax: 312-573-7719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MONSIGNOR MICHAEL M BOLAND
Title or Position: ADMINISTRATOR, PRESIDENT AND CEO
Credential:
Phone: 312-655-7700