Provider Demographics
NPI:1952379554
Name:CATHOLIC CHARITIES OF THE DIOCESE OF SIOUX CITY
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF THE DIOCESE OF SIOUX CITY
Other - Org Name:CATHOLIC CHARITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:712-252-4547
Mailing Address - Street 1:1601 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51103-1715
Mailing Address - Country:US
Mailing Address - Phone:712-252-4547
Mailing Address - Fax:712-252-3785
Practice Address - Street 1:1601 MILITARY RD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51103-1715
Practice Address - Country:US
Practice Address - Phone:712-252-4547
Practice Address - Fax:712-252-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0183434000Medicaid