Healthcare Provider Details

I. General information

NPI: 1982537411
Provider Name (Legal Business Name): COMMUNITY COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11706 S 700 E
DRAPER UT
84020-9365
US

IV. Provider business mailing address

11706 S 700 E
DRAPER UT
84020-9365
US

V. Phone/Fax

Practice location:
  • Phone: 801-523-3479
  • Fax: 801-788-0577
Mailing address:
  • Phone: 801-523-3479
  • Fax: 801-788-0577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: COREY HICKMAN
Title or Position: CEO
Credential:
Phone: 801-410-0160