Healthcare Provider Details

I. General information

NPI: 1568034353
Provider Name (Legal Business Name): A CRE8TIVE HOME SOLUTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 05/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17214 YELLOW PINE ST
WIMAUMA FL
33598-2413
US

IV. Provider business mailing address

17214 YELLOW PINE ST
WIMAUMA FL
33598-2413
US

V. Phone/Fax

Practice location:
  • Phone: 813-433-0193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: LASHONDA SMITH
Title or Position: FINANCIAL OFFICER
Credential:
Phone: 727-307-2233