1629136924 NPI number — CATHOLIC CHARITIES INDPLS, INC

Table of content: (NPI 1629136924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629136924 NPI number — CATHOLIC CHARITIES INDPLS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC CHARITIES INDPLS, 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:
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:
1629136924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 N MERIDIAN ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202-2305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-466-0015
Provider Business Mailing Address Fax Number:
317-261-3375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4609 N. CAPITAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-466-0015
Provider Business Practice Location Address Fax Number:
317-261-3375
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BETHURAM
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
317-236-1530

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200068110B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200068100A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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