Provider Demographics
NPI:1659328557
Name:CATHOLIC CHARITIES SERVICES CORPORATION
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES SERVICES CORPORATION
Other - Org Name:CATHOLIC CHARITIES SERVICES OF WAYNE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-843-5501
Mailing Address - Street 1:521 BEALL AVE
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-3589
Mailing Address - Country:US
Mailing Address - Phone:330-262-7836
Mailing Address - Fax:330-262-2867
Practice Address - Street 1:521 BEALL AVE
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-3589
Practice Address - Country:US
Practice Address - Phone:330-262-7836
Practice Address - Fax:330-262-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10041Medicaid
OH10041Medicaid
OH=========-001OtherINFORMED