Healthcare Provider Details

I. General information

NPI: 1740507102
Provider Name (Legal Business Name): CATHOIC CHARITIES OF THE DIOCESE OF PEORIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 N CHAMBERS ST
GALESBURG IL
61401-3835
US

IV. Provider business mailing address

2900 W HEADING AVE
WEST PEORIA IL
61604-4868
US

V. Phone/Fax

Practice location:
  • Phone: 309-342-1136
  • Fax: 309-342-1891
Mailing address:
  • Phone: 309-636-8012
  • Fax: 309-636-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. PEGGY A ARIZZI
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW, LCSW
Phone: 309-636-8012