Provider Demographics
NPI:1679529549
Name:CATHOLIC CHARITIES SERVCIES CORPORATION
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES SERVCIES CORPORATION
Other - Org Name:CATHOLIC CHARITIES SERVICES OF ASHLAND 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 1:1260 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-4139
Mailing Address - Country:US
Mailing Address - Phone:419-289-1903
Mailing Address - Fax:419-281-8342
Practice Address - Street 1:1260 CENTER ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4139
Practice Address - Country:US
Practice Address - Phone:419-289-1903
Practice Address - Fax:419-281-8342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
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
OH10077Medicaid