Healthcare Provider Details

I. General information

NPI: 1225576812
Provider Name (Legal Business Name): ACOLLECTIVE CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 SPROUL ST
CHESTER PA
19013-4209
US

IV. Provider business mailing address

PO BOX 1121
BROOKHAVEN PA
19015-0121
US

V. Phone/Fax

Practice location:
  • Phone: 484-490-6944
  • Fax: 484-482-6638
Mailing address:
  • Phone: 484-490-6944
  • Fax: 484-482-6638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number142430
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number142430
License Number StatePA

VIII. Authorized Official

Name: BIGE MONYEA CHAMBERS SR.
Title or Position: CEO
Credential:
Phone: 610-800-0550