MEDICARE: CATHOLIC CHARITIES COMMUNITY SERVICES

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	251S00000X	Community/Behavioral Health Agency	BH1013	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	124185	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1871672873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHOLIC CHARITIES COMMUNITY SERVICES

Provider Business Mailing Address
First Line	:	2101 N 4TH ST
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-4200
Country	:	US
Telephone Number	:	928-774-9125
Fax Number	:

Provider Business Practice Location Address
First Line	:	1594 N OATMAN RD
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7308
Country	:	US
Telephone Number	:	928-758-4176
Fax Number	:	928-758-5141

Authorized Official
Title or Position	:	PROGRAMS DIRECTOR
Name	:	BRIGID WAGNER
Credential	:	MA
Telephone Number	:	928-607-3527

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	01/28/2025

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Directions to “CATHOLIC CHARITIES COMMUNITY SERVICES ” Practice Location

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