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General NPI Number Information
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NPI Number | 1285693630
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Entity Type | Organization
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Legal Business Name | CATHOLIC CHARITIES OF THE DIOCESE OF PEORIA
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 502 S MORRIS AVE
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City | BLOOMINGTON
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State | IL
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Zip | 61701-4884
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Country | US
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Telephone | 309-636-8041
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Fax | 309-636-8097
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Provider Business Mailing Address
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Address Line | 2900 W HEADING AVE
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City | WEST PEORIA
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State | IL
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Zip | 61604-4868
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Country | US
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Telephone | 309-636-8012
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Fax | 309-674-1664
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. PEGGY A. ARIZZI
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Credential | MSW, LCSW
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Telephone | 309-636-8012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | IL
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