Provider Demographics
NPI:1700835725
Name:CATHOLIC CHARITIES REGIONAL AGENCY
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES REGIONAL AGENCY
Other - Org Name:CATHOLIC COMMUNITY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:VOITUS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:330-744-3320
Mailing Address - Street 1:2401 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-2405
Mailing Address - Country:US
Mailing Address - Phone:330-744-3320
Mailing Address - Fax:330-744-3677
Practice Address - Street 1:2401 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-2405
Practice Address - Country:US
Practice Address - Phone:330-744-3320
Practice Address - Fax:330-744-3677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
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
OH010104OtherUPI MAHONING CITY OH MEDI
OH0910901Medicaid
0016133OtherCHAMPUS TRICARE