Provider Demographics
NPI:1548705387
Name:CATHOLIC CHARITIES OF THE DIOCESE OF ROCHESTER
Entity type:Organization
Organization Name:CATHOLIC CHARITIES OF THE DIOCESE OF ROCHESTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-546-7220
Mailing Address - Street 1:407 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1609
Mailing Address - Country:US
Mailing Address - Phone:315-331-2300
Mailing Address - Fax:315-331-2301
Practice Address - Street 1:407 E UNION ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1609
Practice Address - Country:US
Practice Address - Phone:315-331-2300
Practice Address - Fax:315-331-2301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES OF DIOCESE OF ROCHESTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-04
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6608OtherNYS OASAS PRU