Provider Demographics
NPI:1376241471
Name:COLLECTIVE COMMUNITIES INCORPORATED
Entity Type:Organization
Organization Name:COLLECTIVE COMMUNITIES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWNDRA
Authorized Official - Middle Name:JOVAN
Authorized Official - Last Name:ECHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-648-5293
Mailing Address - Street 1:110 WALTER WAY UNIT 1562
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9515
Mailing Address - Country:US
Mailing Address - Phone:678-756-1772
Mailing Address - Fax:
Practice Address - Street 1:217 ARROWHEAD BLVD UNIT 81
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1169
Practice Address - Country:US
Practice Address - Phone:770-648-5293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003231691AMedicaid
GA003227996BMedicaid
GA003227996AMedicaid