MEDICARE: CULTURED CREATIVES DEVELOPMENT NON PROFIT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251G00000X	Community Based Hospice Care Agency
4	251K00000X	Public Health or Welfare Agency
5	251S00000X	Community/Behavioral Health Agency
6	251V00000X	Voluntary or Charitable Agency
7	253Z00000X	In Home Supportive Care Agency
8	261Q00000X	Clinic/Center
9	261QP0904X	Federal Public Health Clinic/Center
10	261QP0905X	State or Local Public Health Clinic/Center
11	310400000X	Assisted Living Facility
12	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
13	343900000X	Non-emergency Medical Transport (VAN)
14	385H00000X	Respite Care
15	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1861356248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CULTURED CREATIVES DEVELOPMENT NON PROFIT

Provider Business Mailing Address
First Line	:	5634 WEDGEFIELD ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-2433
Country	:	US
Telephone Number	:	503-422-7798
Fax Number	:

Provider Business Practice Location Address
First Line	:	5634 WEDGEFIELD ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-2433
Country	:	US
Telephone Number	:	503-422-7798
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL/ TRUSTEE,
Name	:	MR. PRESTON PERKINS JR.
Credential	:
Telephone Number	:	503-422-7798

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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