Healthcare Provider Details

I. General information

NPI: 1487543617
Provider Name (Legal Business Name): COLLECTIVE CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4357 13TH AVE S STE 107
FARGO ND
58103-7506
US

IV. Provider business mailing address

4357 13TH AVE S STE 107
FARGO ND
58103-7506
US

V. Phone/Fax

Practice location:
  • Phone: 701-997-9157
  • Fax:
Mailing address:
  • Phone: 701-997-9157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC C HARRIS
Title or Position: MANAGER
Credential: BSHA
Phone: 701-997-9157