Provider Demographics
NPI:1013990407
Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE INC
Entity type:Organization
Organization Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PYAOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-769-3366
Mailing Address - Street 1:3501 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53235-0900
Mailing Address - Country:US
Mailing Address - Phone:414-769-3400
Mailing Address - Fax:262-637-0695
Practice Address - Street 1:503 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4147
Practice Address - Country:US
Practice Address - Phone:920-458-5727
Practice Address - Fax:920-458-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1133261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42128600Medicaid
WI000084012Medicare PIN