Provider Demographics
NPI:1194979708
Name:CREATIVE CONSULTING SERVICES, INC,
Entity type:Organization
Organization Name:CREATIVE CONSULTING SERVICES, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:VANDERPOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-868-5900
Mailing Address - Street 1:353 RESOURCE PKWY
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-8364
Mailing Address - Country:US
Mailing Address - Phone:770-868-5900
Mailing Address - Fax:
Practice Address - Street 1:353 RESOURCE PKWY
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-8364
Practice Address - Country:US
Practice Address - Phone:770-868-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000770591FMedicaid