Provider Demographics
NPI:1194149757
Name:COLLINS CARE SERVICES
Entity type:Organization
Organization Name:COLLINS CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:KRISTINA
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MT ,HHA, CNA
Authorized Official - Phone:317-987-1128
Mailing Address - Street 1:4270 BURKHART WEST DR
Mailing Address - Street 2:D
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1465
Mailing Address - Country:US
Mailing Address - Phone:317-987-1128
Mailing Address - Fax:
Practice Address - Street 1:4270 BURKHART WEST DR
Practice Address - Street 2:D
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1465
Practice Address - Country:US
Practice Address - Phone:317-987-1128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNA1005773320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities