Provider Demographics
NPI:1952387219
Name:CATHOLIC CHARITIES
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES
Other - Org Name:ST FRANCIS COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-523-9201
Mailing Address - Street 1:111 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:BEARDSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62618-1217
Mailing Address - Country:US
Mailing Address - Phone:217-323-5264
Mailing Address - Fax:217-323-4680
Practice Address - Street 1:111 S STATE ST
Practice Address - Street 2:
Practice Address - City:BEARDSTOWN
Practice Address - State:IL
Practice Address - Zip Code:62618-1217
Practice Address - Country:US
Practice Address - Phone:217-323-5264
Practice Address - Fax:217-323-4680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========007Medicaid
IL14 8920Medicare ID - Type Unspecified