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General NPI Number Information
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NPI Number | 1700505617
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Entity Type | Organization
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Legal Business Name | COLLABRIA CARE
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 414 S JEFFERSON ST
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City | NAPA
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State | CA
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Zip | 94559-4515
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Country | US
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Telephone | 707-254-4159
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Fax | 707-699-1557
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Provider Business Mailing Address
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Address Line | PO BOX 31001-3064
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City | PASADENA
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State | CA
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Zip | 91110-3064
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Country | US
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Telephone | 707-254-4159
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Fax | 707-699-1557
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Authorized Official
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Title or Position | ASSISTANT SECRETARY OF ENROLLMENTS
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Name | MR. DONALD W ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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