Provider Demographics
NPI:1801033618
Name:ROCHELLE L. COLLINS, D.O. LLC
Entity Type:Organization
Organization Name:ROCHELLE L. COLLINS, D.O. LLC
Other - Org Name:LIVINGWELL PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:LANGFORD
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-243-3315
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-0217
Mailing Address - Country:US
Mailing Address - Phone:860-243-3315
Mailing Address - Fax:860-243-3820
Practice Address - Street 1:701 COTTAGE GROVE RD
Practice Address - Street 2:SUITE F 120
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3080
Practice Address - Country:US
Practice Address - Phone:860-243-3315
Practice Address - Fax:860-243-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042735261QP2300X
363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty