Healthcare Provider Details

I. General information

NPI: 1689991044
Provider Name (Legal Business Name): CATHOLIC 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

815 2ND ST
LA SALLE IL
61301-2509
US

IV. Provider business mailing address

2900 W HEADING AVE
WEST PEORIA IL
61604-4868
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-4007
  • Fax: 815-244-4550
Mailing address:
  • Phone: 309-636-8012
  • Fax: 309-636-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
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