Provider Demographics
NPI:1700685591
Name:COLLABORATIVE RESIDENTIAL CARE, LLC
Entity type:Organization
Organization Name:COLLABORATIVE RESIDENTIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:804-475-1903
Mailing Address - Street 1:7814 MILL RIVER CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-9238
Mailing Address - Country:US
Mailing Address - Phone:804-475-1903
Mailing Address - Fax:
Practice Address - Street 1:5507 BELLE POND DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-3400
Practice Address - Country:US
Practice Address - Phone:804-475-1903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty