Provider Demographics
NPI:1871239822
Name:COLLECTIVE MIDWIFERY CARE LLC
Entity Type:Organization
Organization Name:COLLECTIVE MIDWIFERY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE, PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIVINE
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:201-230-4464
Mailing Address - Street 1:408 MAIN ST STE 401A
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:866-715-8797
Practice Address - Street 1:408 MAIN ST STE 401A
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1732
Practice Address - Country:US
Practice Address - Phone:201-230-4464
Practice Address - Fax:866-715-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MW00003700OtherOFFICE OF CONSUMER AFFAIRS
NJ25ME00075701OtherBOARD OF MEDICAL EXAMINERS