Provider Demographics
NPI:1033302005
Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF ST PAUL & MPLS
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF ST PAUL & MPLS
Other - Org Name:CATHOLIC CHARITIES AGING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-204-8387
Mailing Address - Street 1:1200 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2513
Mailing Address - Country:US
Mailing Address - Phone:612-204-8387
Mailing Address - Fax:
Practice Address - Street 1:1276 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4101
Practice Address - Country:US
Practice Address - Phone:651-647-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF ST PAUL&MPLS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-23
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN082059800Medicaid