Provider Demographics
NPI:1508079245
Name:COLLIER HEALTH SERVICES INC
Entity Type:Organization
Organization Name:COLLIER HEALTH SERVICES INC
Other - Org Name:IMMOKALEE FAMILY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-658-3003
Mailing Address - Street 1:508 N 9TH ST
Mailing Address - Street 2:SUITE 142
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-3146
Mailing Address - Country:US
Mailing Address - Phone:239-657-6363
Mailing Address - Fax:239-657-1612
Practice Address - Street 1:508 N 9TH ST
Practice Address - Street 2:SUITE 142
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-3146
Practice Address - Country:US
Practice Address - Phone:239-657-6363
Practice Address - Fax:239-657-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029152810Medicaid
FL101822Medicare Oscar/Certification