Provider Demographics
NPI:1821123118
Name:CATHOLIC CHARITIES OF DOR DBA CATHOLIC CHARITIES STEUBEN/LIVINGSTON
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF DOR DBA CATHOLIC CHARITIES STEUBEN/LIVINGSTON
Other - Org Name:CATHOLIC CHARITIES OF STEUBEN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BREWSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-776-8085
Mailing Address - Street 1:23 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1506
Mailing Address - Country:US
Mailing Address - Phone:607-776-8085
Mailing Address - Fax:
Practice Address - Street 1:23 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1506
Practice Address - Country:US
Practice Address - Phone:607-776-8085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00931246Medicaid