Provider Demographics
NPI:1003111550
Name:COLLABORATIVE HOME HEALTH CARE
Entity Type:Organization
Organization Name:COLLABORATIVE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUBUKOLA (BUKI)
Authorized Official - Middle Name:
Authorized Official - Last Name:FABUSIWA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:847-873-9122
Mailing Address - Street 1:1810 LAKE ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4068
Mailing Address - Country:US
Mailing Address - Phone:224-420-2766
Mailing Address - Fax:
Practice Address - Street 1:1810 LAKE ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4068
Practice Address - Country:US
Practice Address - Phone:224-420-2766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health