Provider Demographics
NPI:1982651907
Name:CATHOLIC CHARITIES SERVICES CORPORATION
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES SERVICES CORPORATION
Other - Org Name:CATHOLIC CHARITIES SERVICES OF LORAIN COUNTY
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 1:628 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-4065
Mailing Address - Country:US
Mailing Address - Phone:440-366-1106
Mailing Address - Fax:440-366-5645
Practice Address - Street 1:628 POPLAR ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-4065
Practice Address - Country:US
Practice Address - Phone:440-366-1106
Practice Address - Fax:440-366-5645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder