Provider Demographics
NPI:1790452787
Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF CHICAGO
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-655-7222
Mailing Address - Street 1:721 N. LASALLE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3503
Mailing Address - Country:US
Mailing Address - Phone:312-655-7000
Mailing Address - Fax:
Practice Address - Street 1:101 N CEDAR LAKE RD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-3202
Practice Address - Country:US
Practice Address - Phone:847-546-5733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2023-10-17
Deactivation Date:2023-05-12
Deactivation Code:
Reactivation Date:2023-10-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)