Healthcare Provider Details

I. General information

NPI: 1720494255
Provider Name (Legal Business Name): B-COLL ENTERPRISES L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 CORNELL ST
DEARBORN MI
48124-2503
US

IV. Provider business mailing address

2404 CORNELL ST
DEARBORN MI
48124-2503
US

V. Phone/Fax

Practice location:
  • Phone: 313-605-2216
  • Fax:
Mailing address:
  • Phone: 313-605-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberL237914
License Number StateMI

VIII. Authorized Official

Name: MR. BRIAN ANTHONY COLLINS
Title or Position: OWNER
Credential: OTRL
Phone: 313-605-2216