Healthcare Provider Details

I. General information

NPI: 1538433057
Provider Name (Legal Business Name): CREATIVE INNERVISIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E INDIAN SCHOOL RD STE 415
PHOENIX AZ
85016-8604
US

IV. Provider business mailing address

1616 E INDIAN SCHOOL RD STE 415
PHOENIX AZ
85016-8604
US

V. Phone/Fax

Practice location:
  • Phone: 602-265-8007
  • Fax: 602-265-8013
Mailing address:
  • Phone: 602-265-8007
  • Fax: 602-265-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateAZ

VIII. Authorized Official

Name: MS. LILLIAN R DAVIS
Title or Position: OWNER/ MANAGING DIRCETOR
Credential:
Phone: 602-265-8007