1669506192 NPI number — CATHOLIC CHARITIES ARCHDIOCESE OF SAN ANTONIO INC

Table of content: (NPI 1669506192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669506192 NPI number — CATHOLIC CHARITIES ARCHDIOCESE OF SAN ANTONIO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC CHARITIES ARCHDIOCESE OF SAN ANTONIO INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CATHOLIC COUNSELING & CONSULTATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669506192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7711 MADONNA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78216-6620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-377-1133
Provider Business Mailing Address Fax Number:
210-377-1230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7711 MADONNA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78216-6620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-377-1133
Provider Business Practice Location Address Fax Number:
210-377-1230
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRAVITZ
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
210-377-1133

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  17263 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 17480 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 18632 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 34298 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 36151 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 200928 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 161989201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148203601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 175693402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84444L . This is a "BCBS KRAVITZ" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 86499Q . This is a "BCBS RUTKOWSKI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 84446L . This is a "BCBS KNORR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 143544801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145955401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84445L . This is a "BCBS KLINE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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