1063947331 NPI number — COLLIER HEALTH SERVICES, INC

Table of content: (NPI 1063947331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063947331 NPI number — COLLIER HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLLIER HEALTH SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHILDREN'S CARE WEST
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063947331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1454 MADISON AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IMMOKALEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34142-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-658-3000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1008 GOODLETTE FRANK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34102-5406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-658-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STEELE
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
239-658-3000

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)