Provider Demographics
NPI:1760256887
Name:COLLIER CARE LLC
Entity Type:Organization
Organization Name:COLLIER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:DARCEL
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-915-8954
Mailing Address - Street 1:1906 WOODLAWN AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2132
Mailing Address - Country:US
Mailing Address - Phone:330-915-8954
Mailing Address - Fax:234-214-0523
Practice Address - Street 1:1906 WOODLAWN AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2132
Practice Address - Country:US
Practice Address - Phone:330-915-8954
Practice Address - Fax:234-214-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities