Provider Demographics
NPI:1508917311
Name:CATHOLIC CHARITIES OF DIOCESE OF HARRISBURG PA INC
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF DIOCESE OF HARRISBURG PA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:717-657-4804
Mailing Address - Street 1:4800 UNION DEPOSIT RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3551
Mailing Address - Country:US
Mailing Address - Phone:717-657-4804
Mailing Address - Fax:717-657-8683
Practice Address - Street 1:6156 W CANAL RD
Practice Address - Street 2:
Practice Address - City:ABBOTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17301-8982
Practice Address - Country:US
Practice Address - Phone:717-657-4804
Practice Address - Fax:717-657-8683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA351940251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018539060010Medicaid