Basic Information
Provider Information | |||||||||
NPI: | 1851889828 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CREATIVE SOLUTIONS FOR KIDS & FAMILIES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CREATIVE SOLUTIONS FOR KIDS & FAMILIES | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 7090 | ||||||||
Address2: |   | ||||||||
City: | MORENO VALLEY | ||||||||
State: | CA | ||||||||
PostalCode: | 925527090 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9519249791 | ||||||||
FaxNumber: | 9519249754 | ||||||||
Practice Location | |||||||||
Address1: | 22445 ALESSANDRO BLVD STE 113-116 | ||||||||
Address2: |   | ||||||||
City: | MORENO VALLEY | ||||||||
State: | CA | ||||||||
PostalCode: | 925538358 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9519249791 | ||||||||
FaxNumber: | 9519249754 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/25/2018 | ||||||||
LastUpdateDate: | 10/18/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CASTILLO | ||||||||
AuthorizedOfficialFirstName: | BARBRA | ||||||||
AuthorizedOfficialMiddleName: | BALDON | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
AuthorizedOfficialTelephone: | 9517888812 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/20/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X |   |   | N |   | Agencies | Case Management |   | 253J00000X |   |   | Y |   | Agencies | Foster Care Agency |   |
No ID Information.