MEDICARE: CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE INC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	1132	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285617670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE INC

Provider Business Mailing Address
First Line	:	2021 N 60TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-1641
Country	:	US
Telephone Number	:	414-771-2881
Fax Number	:	414-771-6095

Provider Business Practice Location Address
First Line	:	2021 N 60TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-1641
Country	:	US
Telephone Number	:	414-771-2881
Fax Number	:	414-771-6095

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MS. JULIE A BUSH
Credential	:
Telephone Number	:	262-637-8888

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	05/10/2021

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