Healthcare Provider Details

I. General information

NPI: 1588042931
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE ARCHDIOCESE OF CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 08/24/2026
Certification Date: 05/12/2023
Deactivation Date: 07/08/2026
Reactivation Date: 08/24/2026

III. Provider practice location address

2310 W ROOSEVELT RD SUITE 2W
CHICAGO IL
60608-1131
US

IV. Provider business mailing address

721 N. LASALLE ST.
CHICAGO IL
60654
US

V. Phone/Fax

Practice location:
  • Phone: 312-655-7191
  • Fax:
Mailing address:
  • Phone: 708-655-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number04019
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number04019
License Number StateIL

VIII. Authorized Official

Name: MICHAEL M. BOLAND
Title or Position: ADMINISTRATOR, PRESIDENT, AND CEO
Credential:
Phone: 312-655-7460