Provider Demographics
NPI:1629670088
Name:CATHOLIC CHARITIES OF THE DIOCESE OF PUEBLO
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF THE DIOCESE OF PUEBLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-586-8609
Mailing Address - Street 1:429 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2941
Mailing Address - Country:US
Mailing Address - Phone:719-544-4233
Mailing Address - Fax:
Practice Address - Street 1:429 W 10TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2941
Practice Address - Country:US
Practice Address - Phone:719-544-4233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency