1720090780 NPI number — ST JAMES CATHEDRAL COUNSELING CENTER

Table of content: (NPI 1720090780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720090780 NPI number — ST JAMES CATHEDRAL COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST JAMES CATHEDRAL COUNSELING CENTER
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:
1720090780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 E WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60602-2152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-252-9500
Provider Business Mailing Address Fax Number:
312-337-9243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60602-2152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-252-9500
Provider Business Practice Location Address Fax Number:
312-337-9243
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PREBEL
Authorized Official First Name:
LUCIE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
312-337-5874

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0160-8726 . This is a "BC/BS PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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