Provider Demographics
NPI:1851352959
Name:CATHOLIC CHARITIES OF ASHTABULA COUNTY
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF ASHTABULA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:ASTORINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-992-2121
Mailing Address - Street 1:4200 PARK AVE
Mailing Address - Street 2:FLOOR 3
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6887
Mailing Address - Country:US
Mailing Address - Phone:440-992-2121
Mailing Address - Fax:440-992-5974
Practice Address - Street 1:4200 PARK AVE
Practice Address - Street 2:FLOOR 3
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6887
Practice Address - Country:US
Practice Address - Phone:440-992-2121
Practice Address - Fax:440-992-5974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03397Medicaid
OH9295741Medicare ID - Type UnspecifiedMEDICARE GROUP#