Provider Demographics
NPI:1376706291
Name:CATHOLIC CHARITIES SERVIES
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES SERVIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAXIMINO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S, LICDC
Authorized Official - Phone:440-843-5620
Mailing Address - Street 1:6753 STATE ROAD
Mailing Address - Street 2:PARMADALE/CATHOLIC CHARIITES SERVICES
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-4596
Mailing Address - Country:US
Mailing Address - Phone:440-843-5620
Mailing Address - Fax:440-843-3247
Practice Address - Street 1:6753 STATE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44134-4517
Practice Address - Country:US
Practice Address - Phone:440-843-5620
Practice Address - Fax:440-843-3247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00086783245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children