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General NPI Number Information
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NPI Number | 1699009092
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Entity Type | Organization
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Legal Business Name | CATHOLIC CHARITIES OF THE ARCHDIOCESE OF CHICAGO
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 6202 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60621-2029
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Country | US
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Telephone | 312-655-7984
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Fax |
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Provider Business Mailing Address
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Address Line | 721 N LA SALLE DR
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City | CHICAGO
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State | IL
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Zip | 60654-3503
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR, PRESIDENT AND CEO
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Name | MONSIGNOR MICHAEL M BOLAND
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Credential |
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Telephone | 312-655-7460
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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 | 04019
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License Number State | IL
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Taxonomy #2
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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 | 04019
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License Number State | IL
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