Provider Demographics
NPI:1629463906
Name:CATHOLIC CHARITIES INDIANAPOLIS, INC.
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES INDIANAPOLIS, INC.
Other - Org Name:CATHOLIC CHARITIES INDIANAPOLIS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:BETHURAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-236-1500
Mailing Address - Street 1:1400 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2305
Mailing Address - Country:US
Mailing Address - Phone:317-236-1500
Mailing Address - Fax:
Practice Address - Street 1:1400 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2305
Practice Address - Country:US
Practice Address - Phone:317-236-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000 189106OtherANTHEM
IN100121560AMedicaid