Provider Demographics
NPI:1962185280
Name:CREATIVE HEARTS OUTPATIENT CENTER, LLC
Entity type:Organization
Organization Name:CREATIVE HEARTS OUTPATIENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:MILANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-292-3535
Mailing Address - Street 1:4048 RIVERDALE RD STE 1199
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-1518
Mailing Address - Country:US
Mailing Address - Phone:775-292-3535
Mailing Address - Fax:385-510-2008
Practice Address - Street 1:4048 RIVERDALE RD STE 1199
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-1518
Practice Address - Country:US
Practice Address - Phone:775-292-3535
Practice Address - Fax:385-510-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health