Basic Information
| Provider Information | |||||||||
| NPI: | 1487239349 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CREATIVE HEALTH CARE MANAGEMENT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 S 9TH ST STE 4 | ||||||||
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| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460602631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655243946 | ||||||||
| FaxNumber: | 3177086496 | ||||||||
| Practice Location | |||||||||
| Address1: | 4656 LIVINGSTON RD SE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200323136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025190982 | ||||||||
| FaxNumber: | 3177086496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2021 | ||||||||
| LastUpdateDate: | 03/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | BEAUDRY-ZOBEL | ||||||||
| AuthorizedOfficialFirstName: | MISTY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 3172043736 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 261QR0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.