Provider Demographics
NPI:1306640644
Name:CREER SMALL FAMILY HOME
Entity type:Organization
Organization Name:CREER SMALL FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CREER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-395-8594
Mailing Address - Street 1:17676 VIEW MOUNT CT
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8204
Mailing Address - Country:US
Mailing Address - Phone:323-395-8594
Mailing Address - Fax:
Practice Address - Street 1:17676 VIEW MOUNT CT
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8204
Practice Address - Country:US
Practice Address - Phone:323-395-8594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-04
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children