Provider Demographics
NPI:1164653937
Name:COLLABORATIVE DIABETES CARE, LLC
Entity type:Organization
Organization Name:COLLABORATIVE DIABETES CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PIZZIFRED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-469-6884
Mailing Address - Street 1:9440 BUCHER RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43571-9461
Mailing Address - Country:US
Mailing Address - Phone:419-304-6784
Mailing Address - Fax:888-363-3695
Practice Address - Street 1:4345 SECOR RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4233
Practice Address - Country:US
Practice Address - Phone:419-469-6884
Practice Address - Fax:888-363-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service