Healthcare Provider Details

I. General information

NPI: 1215238829
Provider Name (Legal Business Name): COLLECTIVE HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N HILLSIDE RD
SOUTH DEERFIELD MA
01373-9726
US

IV. Provider business mailing address

110 N HILLSIDE RD
SOUTH DEERFIELD MA
01373-9726
US

V. Phone/Fax

Practice location:
  • Phone: 413-397-9933
  • Fax: 413-397-9961
Mailing address:
  • Phone: 413-397-9933
  • Fax: 413-397-9961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateMA

VIII. Authorized Official

Name: MR. MICHAEL ARCHBALD
Title or Position: CEO
Credential: R.N.
Phone: 413-397-9933