Provider Demographics
NPI:1437480365
Name:CATHOLIC CHARITIES INC DIOCESE OF MADISON
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES INC DIOCESE OF MADISON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FAMILY PROGRAMS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERILYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-826-8014
Mailing Address - Street 1:702 S HIGH POINT RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4925
Mailing Address - Country:US
Mailing Address - Phone:608-826-8010
Mailing Address - Fax:608-826-8027
Practice Address - Street 1:702 S. HIGH POINT ROAD
Practice Address - Street 2:BOX 46550
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53744-6550
Practice Address - Country:US
Practice Address - Phone:608-821-3100
Practice Address - Fax:608-821-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4211-0000Medicaid