Provider Demographics
NPI:1720331739
Name:THE COLLABORATIVE ADULT RELATIONSHIP EXPERIENCES GROUP, LLC
Entity Type:Organization
Organization Name:THE COLLABORATIVE ADULT RELATIONSHIP EXPERIENCES GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSUMER RELATIONS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:712-256-0013
Mailing Address - Street 1:2649 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-2105
Mailing Address - Country:US
Mailing Address - Phone:712-256-0013
Mailing Address - Fax:
Practice Address - Street 1:2649 AVENUE B
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-2105
Practice Address - Country:US
Practice Address - Phone:712-256-0013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA489DLC-443116320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities