Provider Demographics
NPI:1194168021
Name:EFFINGHAM CATHOLIC CHARITIES
Entity type:Organization
Organization Name:EFFINGHAM CATHOLIC CHARITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QUALITY CONTROL
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:217-321-8344
Mailing Address - Street 1:800 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2308
Mailing Address - Country:US
Mailing Address - Phone:217-523-9201
Mailing Address - Fax:217-523-5624
Practice Address - Street 1:1502 EAST FAYETTE AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1017
Practice Address - Country:US
Practice Address - Phone:217-725-3793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES, DIOCESE OF SPRINGFIELD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-10
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL003973-14253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency