Provider Demographics
NPI:1346565496
Name:MADISON COUNTY CATHOLIC CHARITIES
Entity Type:Organization
Organization Name:MADISON COUNTY CATHOLIC CHARITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-523-9201
Mailing Address - Street 1:1625 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-4757
Mailing Address - Country:US
Mailing Address - Phone:217-523-9201
Mailing Address - Fax:217-523-5624
Practice Address - Street 1:3512 MCARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5511
Practice Address - Country:US
Practice Address - Phone:618-462-0634
Practice Address - Fax:618-462-3209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES DIOCESE OF SPRINGFIELD IN ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-01
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL003973253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency