Provider Demographics
NPI:1962029884
Name:CATHOLIC CHARITIES OF THE DIOCESE OF HARRISBURG PA INC
Entity type:Organization
Organization Name:CATHOLIC CHARITIES OF THE DIOCESE OF HARRISBURG PA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:717-657-4804
Mailing Address - Street 1:4800 UNION DEPOSIT RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3710
Mailing Address - Country:US
Mailing Address - Phone:717-657-4804
Mailing Address - Fax:717-657-8683
Practice Address - Street 1:1004 NEW HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-5606
Practice Address - Country:US
Practice Address - Phone:717-657-4804
Practice Address - Fax:717-657-8683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001853906Medicaid