| Catholic Charities Diocese Of Green Bay Inc | |
|
1825 Riverside Drive Green Bay WI 54305-3825 | |
| (920) 272-8234 | |
| (920) 437-4067 |
| Full Name | Catholic Charities Diocese Of Green Bay Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1825 Riverside Drive, Green Bay, Wisconsin |
| Authorized Official Name and Position | Karmen Lemke (DIRECTOR OF CATHOLIC CHARITIES) |
| Authorized Official Contact | 9202728226 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Catholic Charities Diocese Of Green Bay Inc Po Box 23825 Green Bay WI 54305-3825 Ph: (920) 272-8234 | Catholic Charities Diocese Of Green Bay Inc 1825 Riverside Drive Green Bay WI 54305-3825 Ph: (920) 272-8234 |
| NPI Number | 1376769117 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 03/19/2024 |
| Certification Date | 03/19/2024 |
| Medicare PECOS PAC ID | 4486695178 |
|---|---|
| Medicare Enrollment ID | O20050512000438 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376769117 | NPI | - | NPPES |
| 42167700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Debra A Mullen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770660342 PECOS PAC ID: 5991987745 Enrollment ID: I20110315000776 |
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