Provider Demographics
NPI:1962937466
Name:CREATIVE CARE FAMILY SERVICE LLC
Entity type:Organization
Organization Name:CREATIVE CARE FAMILY SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KEYANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-793-1332
Mailing Address - Street 1:3871 N 35TH ST
Mailing Address - Street 2:# 202
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-3075
Mailing Address - Country:US
Mailing Address - Phone:414-793-1332
Mailing Address - Fax:
Practice Address - Street 1:3871 N 35TH ST
Practice Address - Street 2:# 202
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-3075
Practice Address - Country:US
Practice Address - Phone:414-793-1332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-22
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management