Organization
COLLIER HEALTH SERVICES INC
Active
Other names
Golden Gate Dental
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA E STEELE (CHIEF FINANCIAL OFFICER)
(239) 658-3003
Entity
Organization
Contact information
Practice address
1454 MADISON AVE W, IMMOKALEE, FL 34142-2200
(239) 658-3000
(239) 658-3175
Mailing address
1454 MADISON AVE W, IMMOKALEE, FL 34142-2200
(239) 658-3000
(239) 658-3175
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
683955000
—
FL
Enumeration date
05/14/2007
Last updated
12/20/2011
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