Provider Demographics
NPI:1811700107
Name:CATHOLIC CHARITIES COMMUNITY SERVICES, INC
Entity type:Organization
Organization Name:CATHOLIC CHARITIES COMMUNITY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIGID
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:928-607-3527
Mailing Address - Street 1:736 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-3639
Mailing Address - Country:US
Mailing Address - Phone:928-634-4254
Mailing Address - Fax:
Practice Address - Street 1:736 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3639
Practice Address - Country:US
Practice Address - Phone:928-634-4254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health