Provider Demographics
NPI:1194314542
Name:COLLABORATE CARE LLC
Entity type:Organization
Organization Name:COLLABORATE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RECHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:702-767-4963
Mailing Address - Street 1:5538 AUTUMN CLIFFS WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-6103
Mailing Address - Country:US
Mailing Address - Phone:702-767-4963
Mailing Address - Fax:
Practice Address - Street 1:5538 AUTUMN CLIFFS WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-6103
Practice Address - Country:US
Practice Address - Phone:702-767-4963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health