Provider Demographics
NPI:1417251091
Name:CATHOLIC CHARITIES DIOCESE OF GARY INC
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES DIOCESE OF GARY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DEDELOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-886-3549
Mailing Address - Street 1:940 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46402-2906
Mailing Address - Country:US
Mailing Address - Phone:219-886-3549
Mailing Address - Fax:219-886-2828
Practice Address - Street 1:940 BROADWAY
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-2906
Practice Address - Country:US
Practice Address - Phone:219-886-3549
Practice Address - Fax:219-886-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200980410Medicaid
IN170180Medicare UPIN