Provider Demographics
NPI:1083220537
Name:635 COMMUNITY HEALTH COLLECTIVE
Entity Type:Organization
Organization Name:635 COMMUNITY HEALTH COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIOT
Authorized Official - Middle Name:
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-824-1939
Mailing Address - Street 1:635 N 900 W
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-4002
Mailing Address - Country:US
Mailing Address - Phone:801-824-1939
Mailing Address - Fax:
Practice Address - Street 1:635 N 900 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-4002
Practice Address - Country:US
Practice Address - Phone:801-824-1939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty