Provider Demographics
NPI:1902018971
Name:CATHOLIC CHARITIES OF THE DIOCESE ROCHESTER INC
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF THE DIOCESE ROCHESTER INC
Other - Org Name:CATHOLIC CHARITIES COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:VANAUKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-339-9800
Mailing Address - Street 1:94 EXCHANGE STREET
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456
Mailing Address - Country:US
Mailing Address - Phone:315-789-1377
Mailing Address - Fax:315-789-4339
Practice Address - Street 1:1099 JAY STREET, BUILDING J
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611
Practice Address - Country:US
Practice Address - Phone:585-339-9800
Practice Address - Fax:585-339-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01190629OtherMEDICAID PROVIDER ID NUMB