Healthcare Provider Details

I. General information

NPI: 1699009092
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE ARCHDIOCESE OF CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date: 05/12/2023
Reactivation Date: 10/17/2023

III. Provider practice location address

6202 S HALSTED ST
CHICAGO IL
60621-2029
US

IV. Provider business mailing address

721 N LA SALLE DR
CHICAGO IL
60654-3503
US

V. Phone/Fax

Practice location:
  • Phone: 312-655-7984
  • Fax:
Mailing address:
  • Phone:
  • 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: ELLEN TANNENBAUM
Title or Position: DIRECTOR BEHAVIORAL HEALTH
Credential:
Phone: 773-551-3067