Healthcare Provider Details

I. General information

NPI: 1881928398
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE ARCHDIOCESE OF CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 08/24/2026
Certification Date: 05/12/2023
Deactivation Date: 07/23/2026
Reactivation Date: 08/24/2026

III. Provider practice location address

11255 S MICHIGAN AVE
CHICAGO IL
60628-4909
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: MONSIGNOR MICHAEL M BOLAND
Title or Position: ADMINISTRATOR, PRESIDENT AND CEO
Credential:
Phone: 312-655-7460