Provider Demographics
NPI:1700155850
Name:CATHOLIC CHARITIES CYO OF THE ARCHDIOCESE OF SAN FRANCISCO
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES CYO OF THE ARCHDIOCESE OF SAN FRANCISCO
Other - Org Name:CATHOLIC CHARITIES SAN MATEO ADULT DAY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CONTRACTS & GRANTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-972-1265
Mailing Address - Street 1:1555 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3126
Mailing Address - Country:US
Mailing Address - Phone:415-972-1200
Mailing Address - Fax:415-972-1201
Practice Address - Street 1:787 WALNUT ST
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3115
Practice Address - Country:US
Practice Address - Phone:650-592-9325
Practice Address - Fax:650-592-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410504131251V00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11415OtherCITY OF SAN CARLOS BUSINESS REGISTRATION