Healthcare Provider Details

I. General information

NPI: 1376220178
Provider Name (Legal Business Name): COLLABORATIVE SOLUTIONS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 CLARK RD
WILLIAMSTOWN VT
05679-9449
US

IV. Provider business mailing address

PO BOX 320
RICHMOND VT
05477-0320
US

V. Phone/Fax

Practice location:
  • Phone: 802-231-4096
  • Fax: 802-433-1309
Mailing address:
  • Phone: 802-433-6183
  • Fax: 802-434-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: ROB FARRELL
Title or Position: CSC DIRECTOR OF OPERATIONS
Credential: MS
Phone: 802-477-3145