Provider Demographics
NPI:1376615005
Name:COMMONWEALTH CATHOLIC CHARITIES
Entity Type:Organization
Organization Name:COMMONWEALTH CATHOLIC CHARITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:NATTRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-285-5900
Mailing Address - Street 1:1512 WILLOW LAWN DRIVE
Mailing Address - Street 2:P. O. BOX 6565
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-0565
Mailing Address - Country:US
Mailing Address - Phone:804-285-5900
Mailing Address - Fax:804-285-9130
Practice Address - Street 1:1512 WILLOW LAWN DRIVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-0565
Practice Address - Country:US
Practice Address - Phone:804-285-5900
Practice Address - Fax:804-285-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8701571Medicaid
VA8740020Medicaid
VA200042Medicaid
VA200328Medicaid
VA200310Medicaid
VAC04127Medicare PIN
VA8740020Medicaid
VA200310Medicaid