Healthcare Provider Details

I. General information

NPI: 1821576877
Provider Name (Legal Business Name): KREATION RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9941 E 42ND ST
INDIANAPOLIS IN
46235-1675
US

IV. Provider business mailing address

9941 E 42ND ST
INDIANAPOLIS IN
46235-1675
US

V. Phone/Fax

Practice location:
  • Phone: 317-340-8481
  • Fax:
Mailing address:
  • Phone: 317-340-8481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: JAQUITA LATRESS SAVAGE
Title or Position: DIRECTOR
Credential:
Phone: 317-340-8481