Provider Demographics
NPI:1538115308
Name:CATHOLIC CHARITIES SERVICES CORPORATION
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES SERVICES CORPORATION
Other - Org Name:CATHOLIC CHARITIES SERVICES OF MEDINA COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-843-5501
Mailing Address - Street 1:246 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1533
Mailing Address - Country:US
Mailing Address - Phone:330-723-9615
Mailing Address - Fax:330-764-8795
Practice Address - Street 1:246 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1533
Practice Address - Country:US
Practice Address - Phone:330-723-9615
Practice Address - Fax:330-764-8795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQ081049OtherHOMETOWN HEALTH NETWORK
OH10063Medicaid
OH341318421-007OtherMEDICAL MUTUAL
OHCA9289503Medicare ID - Type UnspecifiedMEDICARE (INACTIVE)