Provider Demographics
NPI:1215282926
Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF CHICAGO
Entity type:Organization
Organization Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF CHICAGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEPPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-630-4690
Mailing Address - Street 1:721 N LASALLE ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610
Mailing Address - Country:US
Mailing Address - Phone:312-948-7412
Mailing Address - Fax:312-640-1587
Practice Address - Street 1:721 N LASALLE ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610
Practice Address - Country:US
Practice Address - Phone:312-948-7412
Practice Address - Fax:312-640-1587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF CHICAGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-18
Last Update Date:2023-08-02
Deactivation Date:2023-05-12
Deactivation Code:
Reactivation Date:2023-08-02
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251V00000X, 253Z00000X, 261QA0600X
IL261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care