Provider Demographics
NPI:1104352517
Name:CREATIVE MINDS INC.
Entity type:Organization
Organization Name:CREATIVE MINDS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NORDLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-551-2440
Mailing Address - Street 1:14089 VINTAGE DR SW
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-7394
Mailing Address - Country:US
Mailing Address - Phone:360-551-2440
Mailing Address - Fax:
Practice Address - Street 1:14089 VINTAGE DR SW
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-7394
Practice Address - Country:US
Practice Address - Phone:360-551-2440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment