Provider Demographics
NPI:1902265580
Name:CATHOLIC CHARITIES OF CENTRAL TEXAS
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF CENTRAL TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-651-6100
Mailing Address - Street 1:1625 RUTHERFORD LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5173
Mailing Address - Country:US
Mailing Address - Phone:512-651-6100
Mailing Address - Fax:512-651-6101
Practice Address - Street 1:1625 RUTHERFORD LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5173
Practice Address - Country:US
Practice Address - Phone:512-651-6100
Practice Address - Fax:512-651-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202098251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT713339Medicaid