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:CATHOLIC SOCIAL SERVICES OF THE ARCHDIOCESE OF MILWAUKEE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-637-8888
Mailing Address - Street 1:503 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4147
Mailing Address - Country:US
Mailing Address - Phone:920-458-5727
Mailing Address - Fax:920-458-5826
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:2021-05-10
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