MEDICARE: CATHOLIC CHARITIES CORPORATION

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1942257761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHOLIC CHARITIES CORPORATION

Provider Business Mailing Address
First Line	:	2012 W 25TH ST
Second Line	:	SUITE 507
City	:	CLEVELAND
State	:	OH
Zip	:	44113-4135
Country	:	US
Telephone Number	:	216-696-2197
Fax Number	:	216-696-2088

Provider Business Practice Location Address
First Line	:	2012 W 25TH ST
Second Line	:	SUITE 507
City	:	CLEVELAND
State	:	OH
Zip	:	44113-4135
Country	:	US
Telephone Number	:	216-696-2197
Fax Number	:	216-696-2088

Authorized Official
Title or Position	:	PRESIDENT & CHIEF EXECUTIVE OFICCER
Name	:	MR. PATRICK GAREAU
Credential	:
Telephone Number	:	216-334-2901

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	01/17/2013

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Directions to “CATHOLIC CHARITIES CORPORATION ” Practice Location

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