Provider Demographics
NPI:1457858797
Name:NORTH CREEK LLC
Entity type:Organization
Organization Name:NORTH CREEK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEGALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-505-3381
Mailing Address - Street 1:330 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-1369
Mailing Address - Country:US
Mailing Address - Phone:937-403-9108
Mailing Address - Fax:937-462-1385
Practice Address - Street 1:330 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-1369
Practice Address - Country:US
Practice Address - Phone:405-053-3817
Practice Address - Fax:937-462-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty