1194042259 NPI number — CATHOLIC CHARITIES OF THE DIOCESE OF PEORIA

Table of content: (NPI 1194042259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194042259 NPI number — CATHOLIC CHARITIES OF THE DIOCESE OF PEORIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC CHARITIES OF THE DIOCESE OF PEORIA
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:
6
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:
1194042259
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 W HEADING AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61604-4868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-636-8012
Provider Business Mailing Address Fax Number:
309-636-8097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4703 44TH ST
Provider Second Line Business Practice Location Address:
STE 4
Provider Business Practice Location Address City Name:
ROCK ISLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61201-7189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-786-0770
Provider Business Practice Location Address Fax Number:
309-786-3856
Provider Enumeration Date:
04/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ARIZZI
Authorized Official First Name:
PEGGY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
309-636-8012

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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