Provider Demographics
NPI:1699730499
Name:CATHOLIC CHARITIES COMMUNITY SERVICES CORPORATION
Entity type:Organization
Organization Name:CATHOLIC CHARITIES COMMUNITY SERVICES CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:FINN
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:330-762-7481
Mailing Address - Street 1:812 BIRUTA STREET
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1104
Mailing Address - Country:US
Mailing Address - Phone:330-762-7481
Mailing Address - Fax:330-762-7484
Practice Address - Street 1:640 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3017
Practice Address - Country:US
Practice Address - Phone:330-762-7481
Practice Address - Fax:330-762-7484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0162101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCA9254301OtherGROUP MEDICARE
OHMC441800Medicaid
OHMC441800Medicaid
OH10130Medicare UPIN