Provider Demographics
NPI:1851565485
Name:ST. CHARLES YOUTH & FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:ST. CHARLES YOUTH & FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-476-3710
Mailing Address - Street 1:151 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-1456
Mailing Address - Country:US
Mailing Address - Phone:414-476-3710
Mailing Address - Fax:414-778-5946
Practice Address - Street 1:151 S 84TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-1456
Practice Address - Country:US
Practice Address - Phone:414-476-3710
Practice Address - Fax:414-778-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15371-131251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI15371-131OtherREGULATION & LICENSING
WI39178900Medicaid