Healthcare Provider Details

I. General information

NPI: 1669799672
Provider Name (Legal Business Name): CATHOLIC CHARITIES DIOCESE OF GARY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BROADWAY
GARY IN
46402-2906
US

IV. Provider business mailing address

940 BROADWAY
GARY IN
46402-2906
US

V. Phone/Fax

Practice location:
  • Phone: 219-886-3565
  • Fax: 219-886-2428
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. DUANE D. DEDELOW
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 219-886-3549