Healthcare Provider Details

I. General information

NPI: 1881864379
Provider Name (Legal Business Name): CATHOLIC CHARITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N 7TH ST SUITE A
SPRINGFIELD IL
62702-6352
US

IV. Provider business mailing address

700 N 7TH ST SUITE A
SPRINGFIELD IL
62702-6352
US

V. Phone/Fax

Practice location:
  • Phone: 217-523-1474
  • Fax: 217-523-0194
Mailing address:
  • Phone: 217-523-1474
  • Fax: 217-523-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN E ROACH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 217-523-9201