Provider Demographics
NPI:1891825394
Name:CATHOLIC CHARITIES DIOCESE OF GARY INC
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES DIOCESE OF GARY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIOCESAN DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:219-663-8417
Mailing Address - Street 1:176 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3906
Mailing Address - Country:US
Mailing Address - Phone:219-663-8417
Mailing Address - Fax:219-663-8421
Practice Address - Street 1:321 E 11TH ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3641
Practice Address - Country:US
Practice Address - Phone:219-879-9312
Practice Address - Fax:219-879-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN56030098 50243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200085310Medicaid