NPIMap

Organization Active NPI

Collier Health Services Inc

Doing business as Healthcare Network

  • Federally Qualified Health Center (FQHC)
  • Naples, FL
National Provider Identifier
1558197848
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COLLIER HEALTH SERVICES INC
Doing business as
Healthcare Network
Practice address
1265 Creekside Pkwy Ste 208
Naples, FL 34108-1954
Phone
(239) 658-3000
NPI assigned
Sep 12, 2024
Last updated
Dec 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tami Raznoff
Title
Cfo
Phone
(239) 986-0136

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1265 Creekside Pkwy Ste 208
Naples, FL 34108-1954

Mailing address

1454 Madison Ave W
Immokalee, FL 34142-2200
Phone (239) 658-3000

Other names 1

  • Healthcare Network Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241017003076 FL Part A Provider - Federally Qualified Health Center (FQHC) 4183521925 Practice locations: Naples, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1558197848. Details of each certification follow.

Federally qualified health center certification: CCN C11038

Legal name
COLLIER HEALTH SERVICES, INC
Doing business as
HEALTHCARE NETWORK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 10, 2024
Last certification
Oct 10, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1265 Creekside Pkwy
Ste 208
Naples, FL 34108-1954

Other NPIs with the same Medicare PAC ID 24

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 24

National Provider Directory

National Provider Directory
Tax ID family
Collier Health Services79 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Haris Domond Individual Corporate DirectorBoard Member Apr 17, 2012
Kerri Ervin Individual Corporate DirectorBoard Member Jun 24, 2021
John Fletcher Individual Corporate OfficerCoo Oct 18, 2021 100%
Tami Raznoff Individual Corporate OfficerCfo Jan 1, 2020 100%
W-2 Managing EmployeeCfo Jan 1, 2020
Dennis Brown Individual Corporate DirectorBoard Member Jul 31, 2019
Suzanne Bradach Individual Corporate DirectorBoard Member Sep 27, 2018
Jean Casnel Paul Individual Corporate DirectorBoard Member Nov 27, 2007
Alejandro Castano Individual Corporate DirectorBoard Member Jul 22, 2021
Jerry Starkey Individual Corporate DirectorBoard Member Apr 17, 2014
James Douglas Campbell Individual Corporate DirectorBoard Member Jun 12, 2011

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1558197848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1454 MADISON AVE W",
            "city": "IMMOKALEE",
            "state": "FL",
            "postal_code": "341422200",
            "telephone_number": "239-658-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 CREEKSIDE PKWY STE 208",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341081954",
            "telephone_number": "239-658-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIER HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-12",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "RAZNOFF",
        "authorized_official_first_name": "TAMI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "239-986-0136"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthcare Network",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Healthcare Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Naples, FL

Sources for this page

Verify at the official NPI Registry.