1114006129 NPI number — CATHOLIC CHARITIES COMMUNITY SERVICES

Table of content: (NPI 1114006129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114006129 NPI number — CATHOLIC CHARITIES COMMUNITY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC CHARITIES COMMUNITY SERVICES
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:
Provider Other Organization Name Type Code:
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:
1114006129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4747 N 7TH AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85013-2401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-285-1999
Provider Business Mailing Address Fax Number:
602-285-0311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
519 HALL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGMAN
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86401-6270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-718-1117
Provider Business Practice Location Address Fax Number:
928-718-1124
Provider Enumeration Date:
11/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHMIDT
Authorized Official First Name:
KRISTEN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
602-285-1999

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  BH2608 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110800 . This is a "STATE OF ARIZONA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".