Provider Demographics
NPI:1770890378
Name:KINDRED COLLABORATIVE RESOURCES, INC
Entity type:Organization
Organization Name:KINDRED COLLABORATIVE RESOURCES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:MA-SLP
Authorized Official - Phone:301-563-9833
Mailing Address - Street 1:1300 MERCANTILE LN
Mailing Address - Street 2:SUITE 124 B & C
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5327
Mailing Address - Country:US
Mailing Address - Phone:301-563-9833
Mailing Address - Fax:301-563-9834
Practice Address - Street 1:1300 MERCANTILE LN
Practice Address - Street 2:SUITE 124 B & C
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5327
Practice Address - Country:US
Practice Address - Phone:301-563-9833
Practice Address - Fax:301-563-9834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT010000578225X00000X
DCSLP000207235Z00000X
DCPT870165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty