MONTIQUE S COLLINS , NPI 1811404437 — PHOENIX (AZ)

NPI 1811404437

1+ Years Experience Individual

MONTIQUE S COLLINS

01.04.2018
PROVIDER ENUMERATION DATE
01.04.2018
LAST UPDATE DATE
1811404437
NPI NUMBER

About MONTIQUE S COLLINS

Sole proprietor? Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor.

MONTIQUE S COLLINS is a provider established in PHOENIX, AZ. The NPI number of MONTIQUE S COLLINS is 1811404437 and was assigned on 01.04.2018. The practitioners primary taxonomy code is: 385HR2055X with license number: 6439857 AZ .

Mailing address

  • City: PHOENIX
  • State: AZ
  • Postal code: 85051
  • Phone: 6024554626
  • Fax: 6024554624
  • Address: 3620 W GLENDALE AVE
  • Address 2: 16

Primary Practice Address

  • Region : PHOENIX, AZ
  • NPI : 1811404437
  • Phone : 6024554626
  • Fax : 6024552624
  • Postalcode : 850416763
  • Address : 729 W MALDONADO RD

Provider taxonomy - Respite Care

  • Taxonomy code: 385HR2055X
  • License number: 6439857
  • License state: AZ

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental illness, as respite for the regular caregivers.

Contacts:

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  • MONTIQUE S COLLINS
  • Address : 729 W MALDONADO RD
  • Region : PHOENIX, AZ
  • NPI : 1811404437
  • Phone : 6024554626
  • Fax : 6024552624
  • Postalcode : 850416763

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address729 W MALDONADO RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NamePHOENIX
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameAZ
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code850416763
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number6024554626
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number6024552624
The fax number associated with the location address of the provider being identified.
NPI1811404437
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1385HR2055X
A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental illness, as respite for the regular caregivers.
Provider Enumeration Date01.04.2018
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated01.04.2018
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)MONTIQUE S COLLINS
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address3620 W GLENDALE AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing Address16
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NamePHOENIX
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameAZ
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code85051
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number6024554626
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number6024554624
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1385HR2055X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Respite Care
A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental illness, as respite for the regular caregivers.
Provider License Number 16439857
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1AZ
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeF
  • M - male
  • F - female
Is sole proprietorY
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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