Provider Demographics
NPI:1275862120
Name:CATHOLIC SOCIAL SERVICES MT. VERNON
Entity Type:Organization
Organization Name:CATHOLIC SOCIAL SERVICES MT. VERNON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:618-688-1127
Mailing Address - Street 1:219 WITHERS DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-8273
Mailing Address - Country:US
Mailing Address - Phone:618-244-0344
Mailing Address - Fax:618-244-1455
Practice Address - Street 1:219 WITHERS DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-8273
Practice Address - Country:US
Practice Address - Phone:618-244-0344
Practice Address - Fax:618-244-1455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC SOCIAL SERVICES OF SOUTHERN ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL003967-11253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency