Provider Demographics
NPI:1134534217
Name:COLLINS CAREER CENTER STUDENT BASED HEALTH CENTER
Entity type:Organization
Organization Name:COLLINS CAREER CENTER STUDENT BASED HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CHAFIN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, MA
Authorized Official - Phone:740-867-6641
Mailing Address - Street 1:11627 STATE ROUTE 243
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:OH
Mailing Address - Zip Code:45619-7962
Mailing Address - Country:US
Mailing Address - Phone:740-867-6641
Mailing Address - Fax:740-867-9626
Practice Address - Street 1:11627 SATE ROUTE 243
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:OH
Practice Address - Zip Code:45619-7962
Practice Address - Country:US
Practice Address - Phone:740-867-6641
Practice Address - Fax:740-867-9626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center