Basic Information
| Provider Information | |||||||||
| NPI: | 1376193797 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CREATIVE PATHWAYS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 602 SEMINOLE CREEK WAY | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209043572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403751957 | ||||||||
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| Practice Location | |||||||||
| Address1: | 602 SEMINOLE CREEK WAY | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209043572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403751957 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2019 | ||||||||
| LastUpdateDate: | 09/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | MONROE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | LEWIS | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2403751957 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 251E00000X | N | Agencies | Home Health | 253Z00000X | N | Agencies | In Home Supportive Care | 251C00000X | Y | Agencies | Day Training, Developmentally Disabled Services |
No ID Information.