Provider Demographics
NPI:1942257761
Name:CATHOLIC CHARITIES CORPORATION
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES CORPORATION
Other - Org Name:CATHOLIC CHARITIES SERVICES OF CUYAHOGA COUNTY W 25 CD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFICCER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GAREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-334-2901
Mailing Address - Street 1:2012 W 25TH ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-4135
Mailing Address - Country:US
Mailing Address - Phone:216-696-2197
Mailing Address - Fax:216-696-2088
Practice Address - Street 1:2012 W 25TH ST
Practice Address - Street 2:SUITE 507
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-4135
Practice Address - Country:US
Practice Address - Phone:216-696-2197
Practice Address - Fax:216-696-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9019Medicare UPIN