Healthcare Provider Details

I. General information

NPI: 1164583712
Provider Name (Legal Business Name): CATHOLIC CHARITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4985 AIRPORT RD
SANTA FE NM
87507-1802
US

IV. Provider business mailing address

4985 AIRPORT RD
SANTA FE NM
87507-1802
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-9789
  • Fax: 505-424-9792
Mailing address:
  • Phone: 505-424-9789
  • Fax: 505-424-9792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS KATHLEEN SULLIVAN
Title or Position: DIRECTOR OF COMMUNITY SUPPORT
Credential: PHD
Phone: 505-424-9789