Provider Demographics
NPI:1255439493
Name:CATHOLIC CHARITIES
Entity type:Organization
Organization Name:CATHOLIC CHARITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:BETHURAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-236-1500
Mailing Address - Street 1:803 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3321
Mailing Address - Country:US
Mailing Address - Phone:812-332-1262
Mailing Address - Fax:812-334-8464
Practice Address - Street 1:803 N MONROE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3321
Practice Address - Country:US
Practice Address - Phone:812-332-1262
Practice Address - Fax:812-334-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN703415000OtherMAGELLAN PROVIDER
IN000000 189106OtherANTHEM PROVIDER
IN100121560AMedicaid