Provider Demographics
NPI:1538298401
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:DIOCESAN DIRECTOR
Authorized Official - Prefix:MR
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:219-886-2428
Practice Address - Street 1:2642 ELEANOR ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-3634
Practice Address - Country:US
Practice Address - Phone:219-762-1177
Practice Address - Fax:219-762-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN5603009850243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200085310Medicaid
IN170180Medicare ID - Type Unspecified