Healthcare Provider Details

I. General information

NPI: 1285617670
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 N 60TH ST
MILWAUKEE WI
53208-1641
US

IV. Provider business mailing address

2021 N 60TH ST
MILWAUKEE WI
53208-1641
US

V. Phone/Fax

Practice location:
  • Phone: 414-771-2881
  • Fax: 414-771-6095
Mailing address:
  • Phone: 414-771-2881
  • Fax: 414-771-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1132
License Number StateWI

VIII. Authorized Official

Name: MS. JULIE A BUSH
Title or Position: BILLING MANAGER
Credential:
Phone: 262-637-8888