Provider Demographics
NPI:1184342081
Name:VILLAGE COLLABORATION STATION, PC
Entity type:Organization
Organization Name:VILLAGE COLLABORATION STATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-479-7905
Mailing Address - Street 1:PO BOX 2312
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93011-2312
Mailing Address - Country:US
Mailing Address - Phone:805-603-9237
Mailing Address - Fax:
Practice Address - Street 1:2721 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2803
Practice Address - Country:US
Practice Address - Phone:805-667-2841
Practice Address - Fax:805-948-2846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health