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General NPI Number Information
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NPI Number | 1720331739
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Entity Type | Organization
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Legal Business Name | THE COLLABORATIVE ADULT RELATIONSHIP EXPERIENCES GROUP, LLC
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Dates
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Enumeration Date | 10/16/2012
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | 2649 AVENUE B
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51501-2105
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Country | US
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Telephone | 712-256-0013
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Fax |
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Provider Business Mailing Address
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Address Line | 2649 AVENUE B
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51501-2105
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Country | US
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Telephone | 712-256-0013
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Fax |
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Authorized Official
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Title or Position | CONSUMER RELATIONS DIRECTOR
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Name | MS. JULIE A FLYNN
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Credential | M.S.
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Telephone | 712-256-0013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 489DLC-443116
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License Number State | IA
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