Provider Demographics
NPI:1598232720
Name:COLLINS ADULT RESIDENTIAL CARE, LLC.
Entity Type:Organization
Organization Name:COLLINS ADULT RESIDENTIAL CARE, LLC.
Other - Org Name:COLLINS ADULT RESIDENTIAL CARE, LLC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TOMEEKA
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-888-4559
Mailing Address - Street 1:10 CONNEMARA CT
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-1681
Mailing Address - Country:US
Mailing Address - Phone:215-888-4559
Mailing Address - Fax:856-324-9101
Practice Address - Street 1:444 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2372
Practice Address - Country:US
Practice Address - Phone:215-888-4559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1508222639Medicaid