Healthcare Provider Details

I. General information

NPI: 1982565909
Provider Name (Legal Business Name): CREATIVE SPECIALTY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E BROWN RD
MESA AZ
85203-5046
US

IV. Provider business mailing address

1215 E BROWN RD
MESA AZ
85203-5046
US

V. Phone/Fax

Practice location:
  • Phone: 480-613-0286
  • Fax:
Mailing address:
  • Phone: 480-613-0286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: JULIE JOHNSON
Title or Position: CEO
Credential:
Phone: 480-613-0286