Healthcare Provider Details

I. General information

NPI: 1629251244
Provider Name (Legal Business Name): CATHOLIC CHARITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 W PRAIRIE AVE
DECATUR IL
62523-1220
US

IV. Provider business mailing address

1625 W WASHINGTON ST
SPRINGFIELD IL
62702-4757
US

V. Phone/Fax

Practice location:
  • Phone: 217-428-3458
  • Fax: 217-428-4415
Mailing address:
  • Phone: 217-523-9201
  • Fax: 217-523-5624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number180-004994
License Number StateIL

VIII. Authorized Official

Name: MR. STEVE ROACH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 217-523-9201