Provider Demographics
NPI:1699246272
Name:CREATE REALISTIC CHANGE INC
Entity type:Organization
Organization Name:CREATE REALISTIC CHANGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CALIFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABWOON
Authorized Official - Suffix:
Authorized Official - Credentials:RECOVERY PRACTIONER
Authorized Official - Phone:424-222-1795
Mailing Address - Street 1:531 MAIN ST STE 1132
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3060
Mailing Address - Country:US
Mailing Address - Phone:424-222-1795
Mailing Address - Fax:
Practice Address - Street 1:1873 W 54TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-2604
Practice Address - Country:US
Practice Address - Phone:424-222-1795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty