Provider Demographics
NPI:1114006129
Name:CATHOLIC CHARITIES COMMUNITY SERVICES
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-285-1999
Mailing Address - Street 1:4747 N 7TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-2401
Mailing Address - Country:US
Mailing Address - Phone:602-285-1999
Mailing Address - Fax:602-285-0311
Practice Address - Street 1:519 HALL STREET
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-6270
Practice Address - Country:US
Practice Address - Phone:928-718-1117
Practice Address - Fax:928-718-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH2608251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ110800OtherSTATE OF ARIZONA