Provider Demographics
NPI:1962752402
Name:CATHOLIC CHARITIES, INC. ROMAN CATHOLIC DIOCESE
Entity type:Organization
Organization Name:CATHOLIC CHARITIES, INC. ROMAN CATHOLIC DIOCESE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:STELLRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-821-3100
Mailing Address - Street 1:702 S. HIGH POINT ROAD P.O. BOX 46550
Mailing Address - Street 2:COMMON THREADS
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-3522
Mailing Address - Country:US
Mailing Address - Phone:608-821-3100
Mailing Address - Fax:608-821-3125
Practice Address - Street 1:5979 SIGGELKOW RD
Practice Address - Street 2:COMMON THREADS
Practice Address - City:MC FARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558-9817
Practice Address - Country:US
Practice Address - Phone:608-838-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1137251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health