Provider Demographics
NPI:1285693630
Name:CATHOLIC CHARITIES OF THE DIOCESE OF PEORIA
Entity type:Organization
Organization Name:CATHOLIC CHARITIES OF THE DIOCESE OF PEORIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:309-636-8012
Mailing Address - Street 1:2900 W HEADING AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-4868
Mailing Address - Country:US
Mailing Address - Phone:309-636-8012
Mailing Address - Fax:309-674-1664
Practice Address - Street 1:502 S MORRIS AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-4884
Practice Address - Country:US
Practice Address - Phone:309-636-8041
Practice Address - Fax:309-636-8097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========030Medicaid