Provider Demographics
NPI:1679964308
Name:CATHOLIC CHARITIES OF THE DIOCESE OF JOLIET
Entity type:Organization
Organization Name:CATHOLIC CHARITIES OF THE DIOCESE OF JOLIET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE AND QUALITY PERFORMANCE
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-723-3405
Mailing Address - Street 1:58 E CLINTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-4193
Mailing Address - Country:US
Mailing Address - Phone:815-723-0331
Mailing Address - Fax:815-723-0321
Practice Address - Street 1:201 LIBERTY ST
Practice Address - Street 2:SUITE 241
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450
Practice Address - Country:US
Practice Address - Phone:800-240-7011
Practice Address - Fax:815-941-2563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health