Provider Demographics
NPI:1730527409
Name:COLLABORATIVE COMMUNITY CARE, LLC
Entity type:Organization
Organization Name:COLLABORATIVE COMMUNITY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-431-2996
Mailing Address - Street 1:609 SHIPYARD BLVD
Mailing Address - Street 2:# 106
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6562
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1508 MILITARY CUTOFF RD
Practice Address - Street 2:SUITE 302
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5730
Practice Address - Country:US
Practice Address - Phone:910-431-2996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health