Provider Demographics
NPI:1447301247
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 ROAD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3551
Mailing Address - Country:US
Mailing Address - Phone:717-657-4804
Mailing Address - Fax:717-657-8683
Practice Address - Street 1:120 WILLOW RD STE B
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-2602
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:2007-01-16
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA227076251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01853906Medicaid