Healthcare Provider Details

I. General information

NPI: 1851352959
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF ASHTABULA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 PARK AVE FLOOR 3
ASHTABULA OH
44004-6887
US

IV. Provider business mailing address

4200 PARK AVE FLOOR 3
ASHTABULA OH
44004-6887
US

V. Phone/Fax

Practice location:
  • Phone: 440-992-2121
  • Fax: 440-992-5974
Mailing address:
  • Phone: 440-992-2121
  • Fax: 440-992-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number144
License Number StateOH

VIII. Authorized Official

Name: MR. MARK J ASTORINO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 440-992-2121