Provider Demographics
NPI:1689991044
Name:CATHOLIC CHARITIES OF THE DIOCESE OF PEORIA
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF THE DIOCESE OF PEORIA
Other - Org Name:LASALLE OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:309-636-8012
Mailing Address - Street 1:2900 W HEADING AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-4868
Mailing Address - Country:US
Mailing Address - Phone:309-636-8012
Mailing Address - Fax:309-636-8097
Practice Address - Street 1:815 2ND ST
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-2509
Practice Address - Country:US
Practice Address - Phone:815-223-4007
Practice Address - Fax:815-244-4550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management