Healthcare Provider Details

I. General information

NPI: 1497592992
Provider Name (Legal Business Name): KREATIVE KARE HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 01/15/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 ELK SPUR ST
ELKIN NC
28621-3206
US

IV. Provider business mailing address

137 RHUIDEAN CT
TROUTMAN NC
28166-0249
US

V. Phone/Fax

Practice location:
  • Phone: 704-241-5709
  • Fax:
Mailing address:
  • Phone: 704-241-5709
  • 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
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. DARESHA R LAKEY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 704-241-5709