Provider Demographics
NPI:1013542786
Name:COLLINS FACILITATION SERVICES
Entity Type:Organization
Organization Name:COLLINS FACILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICES FACILITATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:ED S
Authorized Official - Phone:276-395-3484
Mailing Address - Street 1:209 HIGH AVE NE
Mailing Address - Street 2:
Mailing Address - City:COEBURN
Mailing Address - State:VA
Mailing Address - Zip Code:24230-4048
Mailing Address - Country:US
Mailing Address - Phone:276-395-3484
Mailing Address - Fax:
Practice Address - Street 1:209 HIGH AVE NE
Practice Address - Street 2:
Practice Address - City:COEBURN
Practice Address - State:VA
Practice Address - Zip Code:24230-4048
Practice Address - Country:US
Practice Address - Phone:276-395-3484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management