Provider Demographics
NPI:1376220178
Name:COLLABORATIVE SOLUTIONS CORPORATION
Entity Type:Organization
Organization Name:COLLABORATIVE SOLUTIONS CORPORATION
Other - Org Name:SECOND SPRING NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CSC DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:802-477-3145
Mailing Address - Street 1:PO BOX 320
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-0320
Mailing Address - Country:US
Mailing Address - Phone:802-433-6183
Mailing Address - Fax:802-434-3353
Practice Address - Street 1:118 CLARK RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:VT
Practice Address - Zip Code:05679-9449
Practice Address - Country:US
Practice Address - Phone:802-231-4096
Practice Address - Fax:802-433-1309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Single Specialty