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General NPI Number Information
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NPI Number | 1811700107
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Entity Type | Organization
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Legal Business Name | CATHOLIC CHARITIES COMMUNITY SERVICES, INC
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 736 N MAIN ST
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City | COTTONWOOD
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State | AZ
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Zip | 86326-3639
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Country | US
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Telephone | 928-634-4254
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Fax |
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Provider Business Mailing Address
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Address Line | 736 N MAIN ST
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City | COTTONWOOD
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State | AZ
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Zip | 86326-3639
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Country | US
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Telephone | 928-634-4254
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Fax |
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Authorized Official
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Title or Position | PROGRAMS DIRECTOR
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Name | BRIGID WAGNER
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Credential | MA
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Telephone | 928-607-3527
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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 |
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License Number State |
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