MEDICARE: CATHOLIC CHARITIES CORPROATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3245S0500X	Children's Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1225396021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHOLIC CHARITIES CORPROATION

Provider Business Mailing Address
First Line	:	7911 DETROIT AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-2815
Country	:	US
Telephone Number	:	216-391-2030
Fax Number	:

Provider Business Practice Location Address
First Line	:	3135 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2531
Country	:	US
Telephone Number	:	216-391-2030
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. PATRICK GAREAU
Credential	:
Telephone Number	:	216-334-2901

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	01/17/2013

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Directions to “CATHOLIC CHARITIES CORPROATION ” Practice Location

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