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General NPI Number Information
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NPI Number | 1528304367
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Entity Type | Organization
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Legal Business Name | CATHOLIC CHARITIES COMMUNITY SERVICES
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Dates
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Enumeration Date | 12/26/2012
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 434 W GURLEY ST
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City | PRESCOTT
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State | AZ
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Zip | 86301-3616
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Country | US
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Telephone | 928-778-2531
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Fax | 928-771-9531
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Provider Business Mailing Address
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Address Line | 5151 N 19TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85015-3224
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Country | US
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Telephone | 480-250-9157
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Fax |
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Authorized Official
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Title or Position | RESOURCE SUPPORT SPECIALIST
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Name | JOHN LANG
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Credential |
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Telephone | 928-864-7371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | BH-3155
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License Number State | AZ
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