Healthcare Provider Details

I. General information

NPI: 1275474223
Provider Name (Legal Business Name): BC COLLECTIVE OF GA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W WINTER ST
DELAWARE OH
43015-4634
US

IV. Provider business mailing address

133 NE 2ND AVE APT 1107
MIAMI FL
33132-2910
US

V. Phone/Fax

Practice location:
  • Phone: 855-221-2642
  • Fax: 404-565-4955
Mailing address:
  • Phone: 855-221-2642
  • Fax: 404-565-4955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SABA HAQ
Title or Position: PRESIDENT
Credential:
Phone: 949-463-0650