Provider Demographics
NPI:1558074088
Name:635 COMMUNITY HEALTH COLLECTIVE
Entity Type:Organization
Organization Name:635 COMMUNITY HEALTH COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIOT
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:801-824-1939
Mailing Address - Street 1:209 WACHUSETT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 WACHUSETT ST APT 1
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4233
Practice Address - Country:US
Practice Address - Phone:801-441-0176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty