Provider Demographics
NPI:1174877641
Name:CATHOLIC CHARITIES
Entity type:Organization
Organization Name:CATHOLIC CHARITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:712-252-4547
Mailing Address - Street 1:1200 3RD AVE NW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-2207
Mailing Address - Country:US
Mailing Address - Phone:515-576-4156
Mailing Address - Fax:515-576-6998
Practice Address - Street 1:1200 3RD AVE NW
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-2207
Practice Address - Country:US
Practice Address - Phone:515-576-4156
Practice Address - Fax:515-576-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty