Healthcare Provider Details

I. General information

NPI: 1689596181
Provider Name (Legal Business Name): COLL MENTORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 N 67TH AVE UNIT 1109
PHOENIX AZ
85033-1670
US

IV. Provider business mailing address

4545 N 67TH AVE UNIT 1109
PHOENIX AZ
85033-1670
US

V. Phone/Fax

Practice location:
  • Phone: 954-544-9065
  • Fax:
Mailing address:
  • Phone: 954-544-9065
  • Fax: 954-544-9065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: COLLINS AYEAH
Title or Position: OWNER
Credential:
Phone: 954-544-9065