Provider Demographics
NPI:1891567863
Name:COLLECTIVE HEALTH SPA, PLLC
Entity Type:Organization
Organization Name:COLLECTIVE HEALTH SPA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TOYA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BEATTIE
Authorized Official - Suffix:
Authorized Official - Credentials:PBT
Authorized Official - Phone:708-372-0508
Mailing Address - Street 1:19900 GOVERNORS DR # LL-14
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1057
Mailing Address - Country:US
Mailing Address - Phone:708-372-0508
Mailing Address - Fax:855-487-0292
Practice Address - Street 1:19900 GOVERNORS DR # LL-14
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1057
Practice Address - Country:US
Practice Address - Phone:708-372-0508
Practice Address - Fax:855-487-0292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLLECTIVE HEALTH SPA, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-24
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty