Healthcare Provider Details

I. General information

NPI: 1245646272
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE ARCHDIOCESE OF CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date: 05/12/2023
Reactivation Date: 05/31/2023

III. Provider practice location address

1717 RAND RD
DES PLAINES IL
60016-3509
US

IV. Provider business mailing address

1800 N HERMITAGE AVE
CHICAGO IL
60622-1161
US

V. Phone/Fax

Practice location:
  • Phone: 847-376-2100
  • Fax:
Mailing address:
  • Phone: 312-655-7167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number04019
License Number StateIL

VIII. Authorized Official

Name: PAMELA F DAVIS
Title or Position: DEPARTMENT DIRECTOR
Credential:
Phone: 312-655-7167