Healthcare Provider Details

I. General information

NPI: 1326580713
Provider Name (Legal Business Name): CREATIVE ENDINGS SOCIAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4165 MILLERSVILLE RD
INDIANAPOLIS IN
46205-2989
US

IV. Provider business mailing address

4165 MILLERSVILLE RD
INDIANAPOLIS IN
46205-2989
US

V. Phone/Fax

Practice location:
  • Phone: 317-622-4104
  • Fax: 317-737-2320
Mailing address:
  • Phone: 317-622-4104
  • Fax: 317-737-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. VERNON LEE THOMAS III
Title or Position: DIRECTOR OF BUSINESS DEVELOPMENT
Credential: JD
Phone: 317-622-4104