Healthcare Provider Details

I. General information

NPI: 1427735117
Provider Name (Legal Business Name): JCREATIVE3000
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S EDSEL ST
DETROIT MI
48217-2405
US

IV. Provider business mailing address

3201 S EDSEL ST
DETROIT MI
48217-2405
US

V. Phone/Fax

Practice location:
  • Phone: 586-625-9704
  • Fax:
Mailing address:
  • Phone: 586-625-9704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE SPROLES
Title or Position: ADMINISTRATOR
Credential: HHA
Phone: 586-625-9704