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General NPI Number Information
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NPI Number | 1700685591
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE RESIDENTIAL CARE, LLC
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 5507 BELLE POND DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23234-3400
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Country | US
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Telephone | 804-475-1903
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Fax |
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Provider Business Mailing Address
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Address Line | 7814 MILL RIVER CT
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City | CHESTERFIELD
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State | VA
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Zip | 23832-9238
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Country | US
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Telephone | 804-475-1903
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MS. CELESTE BROOKS
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Credential | RN
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Telephone | 804-475-1903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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