Provider Demographics
NPI:1689453896
Name:COLLABRACARE INC.
Entity Type:Organization
Organization Name:COLLABRACARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YADENITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-213-5226
Mailing Address - Street 1:15611 PRODUCT LN STE B11
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1305
Mailing Address - Country:US
Mailing Address - Phone:323-524-9348
Mailing Address - Fax:323-784-2991
Practice Address - Street 1:15611 PRODUCT LN STE B11
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1305
Practice Address - Country:US
Practice Address - Phone:323-524-9348
Practice Address - Fax:323-784-2991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management