Provider Demographics
NPI:1376769117
Name:CATHOLIC CHARITIES OF THE DIOCESE OF GREEN BAY INC
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF THE DIOCESE OF GREEN BAY INC
Other - Org Name:CATHOLIC CHARITIES DIOCESE OF GREEN BAY INC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CATHOLIC CHARITIES
Authorized Official - Prefix:
Authorized Official - First Name:KARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-272-8226
Mailing Address - Street 1:PO BOX 23825
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-3825
Mailing Address - Country:US
Mailing Address - Phone:920-272-8234
Mailing Address - Fax:920-437-4067
Practice Address - Street 1:1825 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54305-3825
Practice Address - Country:US
Practice Address - Phone:920-272-8234
Practice Address - Fax:920-437-4067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42167700Medicaid
WI42167700Medicaid