Provider Demographics
NPI:1235112020
Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE INC
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE INC
Other - Org Name:CATHOLIC SOCIAL SERVICES OF THE ARCHDIOCESE OF MILWAUKEE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:414-769-3616
Mailing Address - Street 1:7635 W OKLAHOMA AVE
Mailing Address - Street 2:#104
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-3600
Mailing Address - Country:US
Mailing Address - Phone:414-541-3624
Mailing Address - Fax:414-541-0063
Practice Address - Street 1:7635 W OKLAHOMA AVE
Practice Address - Street 2:#104
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-3600
Practice Address - Country:US
Practice Address - Phone:414-541-3624
Practice Address - Fax:414-541-3624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2400261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42162300Medicaid
WI84012Medicare ID - Type Unspecified