Provider Demographics
NPI:1124431788
Name:CREATIONS-UNLIMITED
Entity type:Organization
Organization Name:CREATIONS-UNLIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-519-8009
Mailing Address - Street 1:6453 GOLDENROD CT
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-5330
Mailing Address - Country:US
Mailing Address - Phone:804-519-8009
Mailing Address - Fax:804-525-5444
Practice Address - Street 1:318 MOORE ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2551
Practice Address - Country:US
Practice Address - Phone:804-519-8009
Practice Address - Fax:804-525-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency