Provider Demographics
NPI:1306355748
Name:CATHOLIC CHARITIES DIOCESE OF TRENTON
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES DIOCESE OF TRENTON
Other - Org Name:URBAN COLLABORATIVE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONTCUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-394-3202
Mailing Address - Street 1:383 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-5705
Mailing Address - Country:US
Mailing Address - Phone:609-394-3202
Mailing Address - Fax:
Practice Address - Street 1:832 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-3847
Practice Address - Country:US
Practice Address - Phone:609-394-3202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty