Healthcare Provider Details

I. General information

NPI: 1841926102
Provider Name (Legal Business Name): CREATIVE COMP SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 DOUGLAS AVE STE 177
ALTAMONTE SPRINGS FL
32714-5200
US

IV. Provider business mailing address

1170 TREE SWALLOW DR STE 377
WINTER SPRINGS FL
32708-2826
US

V. Phone/Fax

Practice location:
  • Phone: 888-211-8021
  • Fax: 407-917-7095
Mailing address:
  • Phone: 407-421-1690
  • Fax: 407-917-7095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: JAMES A CALDWELL
Title or Position: CFO
Credential:
Phone: 407-990-1064