Provider Demographics
NPI:1679619910
Name:CATHOLIC CHARITIES CYO
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES CYO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:650-295-2192
Mailing Address - Street 1:36 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-4405
Mailing Address - Country:US
Mailing Address - Phone:650-295-2192
Mailing Address - Fax:
Practice Address - Street 1:36 37TH AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-4405
Practice Address - Country:US
Practice Address - Phone:650-295-2192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health