Provider Demographics
NPI:1275795262
Name:CATHOLIC CHARITIES
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SR BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-663-8417
Mailing Address - Street 1:321 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360
Mailing Address - Country:US
Mailing Address - Phone:219-879-9312
Mailing Address - Fax:219-879-9073
Practice Address - Street 1:321 W 11TH ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360
Practice Address - Country:US
Practice Address - Phone:219-879-9312
Practice Address - Fax:219-879-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1891825394Medicaid