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General NPI Number Information
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NPI Number | 1982537411
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Entity Type | Organization
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Legal Business Name | COMMUNITY COLLECTIVE, LLC
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Dates
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Enumeration Date | 06/04/2026
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Last Update Date | 06/04/2026
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Provider Practice Location Address
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Address Line | 11706 S 700 E
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City | DRAPER
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State | UT
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Zip | 84020-9365
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Country | US
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Telephone | 801-523-3479
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Fax | 801-788-0577
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Provider Business Mailing Address
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Address Line | 11706 S 700 E
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City | DRAPER
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State | UT
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Zip | 84020-9365
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Country | US
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Telephone | 801-523-3479
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Fax | 801-788-0577
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Authorized Official
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Title or Position | CEO
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Name | COREY HICKMAN
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Credential |
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Telephone | 801-410-0160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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