Provider Demographics
NPI:1831467299
Name:COLLABORATIVE HEALTHCARE
Entity Type:Organization
Organization Name:COLLABORATIVE HEALTHCARE
Other - Org Name:RATLIFF PRIVATE HOME CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRAWICK
Authorized Official - Suffix:
Authorized Official - Credentials:CLINICAL NURSE SPEC
Authorized Official - Phone:478-295-2626
Mailing Address - Street 1:187 ROBERSON MILL RD NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-4960
Mailing Address - Country:US
Mailing Address - Phone:478-295-2626
Mailing Address - Fax:478-295-2630
Practice Address - Street 1:187 ROBERSON MILL RD NE
Practice Address - Street 2:SUITE 201
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-4960
Practice Address - Country:US
Practice Address - Phone:478-295-2626
Practice Address - Fax:478-295-2630
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RATLIFF PRIVATE HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002023247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1255633368Medicare PIN
GA1255633368Medicare PIN