Provider Demographics
NPI:1124268305
Name:CATHOLIC HEALTH SYSTEM PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY,
Entity type:Organization
Organization Name:CATHOLIC HEALTH SYSTEM PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KLUCKHOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-604-1842
Mailing Address - Street 1:55 MELROY AVE
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-1658
Mailing Address - Country:US
Mailing Address - Phone:716-819-5101
Mailing Address - Fax:716-819-5099
Practice Address - Street 1:55 MELROY AVE
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1658
Practice Address - Country:US
Practice Address - Phone:716-819-5101
Practice Address - Fax:716-819-5099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLOC HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization