Provider Demographics
NPI:1992876031
Name:CREATIVE HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:CREATIVE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-861-5263
Mailing Address - Street 1:PO BOX 4805
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-4805
Mailing Address - Country:US
Mailing Address - Phone:336-861-5263
Mailing Address - Fax:336-861-5263
Practice Address - Street 1:311 TRINDALE RD
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-2751
Practice Address - Country:US
Practice Address - Phone:336-861-5263
Practice Address - Fax:336-861-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3477251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health