Provider Demographics
NPI:1235240474
Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF ST PAUL AND MPLS
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF ST PAUL AND MPLS
Other - Org Name:ST JOSEPHS HOME FOR CHILDREN
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:
Mailing Address - Fax:
Practice Address - Street 1:1121 E 46TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3562
Practice Address - Country:US
Practice Address - Phone:612-204-8217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN592218600Medicaid