Provider Demographics
NPI:1104156439
Name:CATHOLIC SOCIAL SERVICES CARBONDALE
Entity type:Organization
Organization Name:CATHOLIC SOCIAL SERVICES CARBONDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:618-688-1127
Mailing Address - Street 1:214 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2925
Mailing Address - Country:US
Mailing Address - Phone:618-351-0743
Mailing Address - Fax:618-351-0945
Practice Address - Street 1:214 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2925
Practice Address - Country:US
Practice Address - Phone:618-351-0743
Practice Address - Fax:618-351-0945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC SOCIAL SERVICES OF SOUTHERN ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL003967-11253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency