Provider Demographics
NPI:1891741740
Name:CATHOLIC CHARITIES SERVICES CORPORATION
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES SERVICES CORPORATION
Other - Org Name:CATHOLIC CAHRITIES SERVICES OF GEAUGA COUNTIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-843-5501
Mailing Address - Street 1:10771 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9323
Mailing Address - Country:US
Mailing Address - Phone:440-285-3537
Mailing Address - Fax:440-285-4909
Practice Address - Street 1:10771 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9323
Practice Address - Country:US
Practice Address - Phone:440-285-3537
Practice Address - Fax:440-285-4909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH06854OtherOTHER SOURCE
OHMC-19-04Medicaid
OHCA9257221Medicare ID - Type UnspecifiedMEDICARE