Provider Demographics
NPI:1609953223
Name:CATHOLIC CHARITIES OF THE DIOCESE OF JOLIET
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF THE DIOCESE OF JOLIET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ARELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-723-3405
Mailing Address - Street 1:16555 WEBER RD
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-8719
Mailing Address - Country:US
Mailing Address - Phone:815-723-0331
Mailing Address - Fax:815-723-0321
Practice Address - Street 1:203 N OTTAWA ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-4006
Practice Address - Country:US
Practice Address - Phone:815-723-0331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL310-492251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932230OtherBLUE CROSS BLUE SHIELD