Healthcare Provider Details

I. General information

NPI: 1750970356
Provider Name (Legal Business Name): CREATIVE HEALTH CARE MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GAUSE BLVD E
SLIDELL LA
70461-4223
US

IV. Provider business mailing address

10 S 9TH ST STE 4
NOBLESVILLE IN
46060-2631
US

V. Phone/Fax

Practice location:
  • Phone: 985-781-4545
  • Fax: 317-708-6496
Mailing address:
  • Phone: 317-204-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MISTY D BEAUDRY-ZOBEL
Title or Position: REIMBURSEMENT
Credential:
Phone: 317-204-3736