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General NPI Number Information
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NPI Number | 1104156439
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Entity Type | Organization
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Legal Business Name | CATHOLIC SOCIAL SERVICES CARBONDALE
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 01/08/2010
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Provider Practice Location Address
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Address Line | 214 S UNIVERSITY AVE
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City | CARBONDALE
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State | IL
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Zip | 62901-2925
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Country | US
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Telephone | 618-351-0743
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Fax | 618-351-0945
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Provider Business Mailing Address
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Address Line | 214 S UNIVERSITY AVE
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City | CARBONDALE
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State | IL
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Zip | 62901-2925
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Country | US
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Telephone | 618-351-0743
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Fax | 618-351-0945
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Authorized Official
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Title or Position | FINANCE DIRECTOR
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Name | MR. GARY B SCHMITT
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Credential | MBA
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Telephone | 618-688-1127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 003967-11
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License Number State | IL
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