Provider Demographics
NPI:1659304129
Name:CATHOLIC CHARITIES OF SOUTHWESTERN OHIO
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF SOUTHWESTERN OHIO
Other - Org Name:CATHOLIC CHARITIES SOUTHWESTERN OHIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-241-7745
Mailing Address - Street 1:1910 FAIRGROVE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-1930
Mailing Address - Country:US
Mailing Address - Phone:513-863-6129
Mailing Address - Fax:513-863-0524
Practice Address - Street 1:1910 FAIRGROVE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-1930
Practice Address - Country:US
Practice Address - Phone:513-863-6129
Practice Address - Fax:513-863-0524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10058Medicaid
OH2919677Medicaid