Provider Demographics
NPI:1376860437
Name:CATHOLIC CHARITEIS OF THE DIOCESE OF PEORAI
Entity Type:Organization
Organization Name:CATHOLIC CHARITEIS OF THE DIOCESE OF PEORAI
Other - Org Name:BLDG B
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:309-636-8012
Mailing Address - Street 1:2900 W HEADING AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-4868
Mailing Address - Country:US
Mailing Address - Phone:309-636-8012
Mailing Address - Fax:309-636-8097
Practice Address - Street 1:2900 W HEADING AVE
Practice Address - Street 2:BLDG B
Practice Address - City:WEST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-4868
Practice Address - Country:US
Practice Address - Phone:309-636-8012
Practice Address - Fax:309-636-8097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health