Provider Demographics
NPI:1962748525
Name:CREATIVE CARE SOLUTIONS LLC
Entity type:Organization
Organization Name:CREATIVE CARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-542-5695
Mailing Address - Street 1:PO BOX 19012
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27419-9012
Mailing Address - Country:US
Mailing Address - Phone:336-542-5695
Mailing Address - Fax:866-936-0112
Practice Address - Street 1:3723 W MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1590
Practice Address - Country:US
Practice Address - Phone:336-542-5695
Practice Address - Fax:866-936-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health