Provider Demographics
NPI:1932127735
Name:CATHOLIC CHARITIES INC DIOCESE OF MADISON
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES INC DIOCESE OF MADISON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF PROGRAMS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDENWALDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-826-8000
Mailing Address - Street 1:702 S HIGH POINT RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4926
Mailing Address - Country:US
Mailing Address - Phone:608-826-8000
Mailing Address - Fax:608-826-8026
Practice Address - Street 1:702 S HIGH POINT RD STE 201
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-4926
Practice Address - Country:US
Practice Address - Phone:608-826-8000
Practice Address - Fax:608-826-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
WI261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4211-0000Medicaid
WI000084765Medicare PIN
WI4211-0000Medicaid