Healthcare Provider Details

I. General information

NPI: 1780104034
Provider Name (Legal Business Name): CREATION CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3292 PLUMLEE CT
GRAND ISLAND FL
32735-9013
US

IV. Provider business mailing address

3292 PLUMLEE CT
GRAND ISLAND FL
32735-9013
US

V. Phone/Fax

Practice location:
  • Phone: 352-551-4840
  • Fax:
Mailing address:
  • Phone: 352-551-4840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA MCKENZIE
Title or Position: PRESIDENT
Credential:
Phone: 352-551-4840