Provider Demographics
NPI:1972506624
Name:COLLABRIA CARE
Entity Type:Organization
Organization Name:COLLABRIA CARE
Other - Org Name:COLLABRIA DAY PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:REGALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:707-258-9087
Mailing Address - Street 1:414 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-4515
Mailing Address - Country:US
Mailing Address - Phone:707-258-9087
Mailing Address - Fax:707-254-4157
Practice Address - Street 1:414 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-4515
Practice Address - Country:US
Practice Address - Phone:707-258-9087
Practice Address - Fax:707-254-4157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-25
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000499261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70129FMedicaid