NPIMap

Organization Active NPI

St. Charles

  • Community/Behavioral Health Agency
  • Milwaukee, WI
National Provider Identifier
1376718320
Registry record updated Apr 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
15361131 Issued in WI
Legal business name
ST. CHARLES
Practice address
4757 N 76TH St
Milwaukee, WI 53218-4732
Phone
(414) 358-4145
Fax
(414) 358-5002
NPI assigned
Apr 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Katherine Anna Dibb, 15361131
Title
Substance Abuse Counselor
Phone
(414) 358-5381

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 15361131 WI Primary

Addresses

Primary practice location

4757 N 76TH St
Milwaukee, WI 53218-4732

Mailing address

4757 N 76TH St
Milwaukee, WI 53218-4732
Phone (414) 358-4145

Other identifiers 1

IdentifierTypeStateIssuer
3918300MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
St Charles Youth Family Services Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1376718320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4757 N 76TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532184732",
            "telephone_number": "414-358-4145",
            "fax_number": "414-358-5002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4757 N 76TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532184732",
            "telephone_number": "414-358-4145",
            "fax_number": "414-358-5002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CHARLES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "DIBB",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "ANNA",
        "authorized_official_title_or_position": "SUBSTANCE ABUSE COUNSELOR",
        "authorized_official_telephone_number": "414-358-5381",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "15361131"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "15361131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3918300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.