Provider Demographics
NPI:1700348133
Name:COLLABORATIVE HEALTH AND REHABILITATION SERVICES, INC
Entity Type:Organization
Organization Name:COLLABORATIVE HEALTH AND REHABILITATION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CLINICAL OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:601-551-5429
Mailing Address - Street 1:4023 FRED MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-8019
Mailing Address - Country:US
Mailing Address - Phone:601-551-5429
Mailing Address - Fax:888-829-3398
Practice Address - Street 1:1068 BUCK CIR
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666-9723
Practice Address - Country:US
Practice Address - Phone:601-551-4779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty