Provider Demographics
NPI:1285975326
Name:NEW CREATIVE CARE
Entity type:Organization
Organization Name:NEW CREATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOTKIA
Authorized Official - Middle Name:SHENEE
Authorized Official - Last Name:DELAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:414-254-8216
Mailing Address - Street 1:5151 N 58TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4251
Mailing Address - Country:US
Mailing Address - Phone:414-395-3819
Mailing Address - Fax:414-395-3819
Practice Address - Street 1:5151 N 58TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4251
Practice Address - Country:US
Practice Address - Phone:414-395-3819
Practice Address - Fax:414-395-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI243369311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI243369OtherCNA