Healthcare Provider Details

I. General information

NPI: 1215232277
Provider Name (Legal Business Name): CREATVE MINDS DAY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 PINTAIL CT
MARTINEZ GA
30907-8872
US

IV. Provider business mailing address

4570 PINTAIL CT
MARTINEZ GA
30907-8872
US

V. Phone/Fax

Practice location:
  • Phone: 706-834-8106
  • Fax:
Mailing address:
  • Phone: 706-834-8106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number261QA0600X
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number261QM0850X
License Number StateGA

VIII. Authorized Official

Name: CHANDRA JONES
Title or Position: OWNER
Credential:
Phone: 706-834-8106