Provider Demographics
NPI:1891518908
Name:COLLABORATIVE LIVING INC
Entity type:Organization
Organization Name:COLLABORATIVE LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KENYARDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-810-3169
Mailing Address - Street 1:1000 MAIN ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-6353
Mailing Address - Country:US
Mailing Address - Phone:281-810-3169
Mailing Address - Fax:
Practice Address - Street 1:1000 MAIN ST STE 2300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-6353
Practice Address - Country:US
Practice Address - Phone:281-810-3169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health