1477804680 NPI number — COLLABORATIVE ARTHRITIS CARE, INC

Table of content: (NPI 1477804680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477804680 NPI number — COLLABORATIVE ARTHRITIS CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLLABORATIVE ARTHRITIS CARE, 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:
Provider Other Organization Name Type Code:
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:
1477804680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300A TEMPLE LAKE DR STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLONIAL HEIGHTS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23834-2972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-524-2400
Provider Business Mailing Address Fax Number:
804-526-1852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300A TEMPLE LAKE DR STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLONIAL HEIGHTS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23834-2972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-524-2400
Provider Business Practice Location Address Fax Number:
804-526-1852
Provider Enumeration Date:
09/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ALVIS
Authorized Official First Name:
DEE DEE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE SERVICES MANAGER
Authorized Official Telephone Number:
804-518-1317

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  0101238458 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com