Healthcare Provider Details

I. General information

NPI: 1598417438
Provider Name (Legal Business Name): NEW CREATION HOMES AND SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/21/2022
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 NW 234TH AVE
ALACHUA FL
32615-4144
US

IV. Provider business mailing address

5310 NW 234TH AVE
ALACHUA FL
32615-4144
US

V. Phone/Fax

Practice location:
  • Phone: 352-317-1550
  • Fax:
Mailing address:
  • Phone: 352-317-1550
  • 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 Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. REGINA BRADLEY
Title or Position: OWNER
Credential:
Phone: 352-317-1550