Healthcare Provider Details

I. General information

NPI: 1235810102
Provider Name (Legal Business Name): CREATIVE SUPPORTIVE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N CRANBERRY LN
ROCHESTER NH
03867-5219
US

IV. Provider business mailing address

11 N CRANBERRY LN
ROCHESTER NH
03867-5219
US

V. Phone/Fax

Practice location:
  • Phone: 603-534-6719
  • Fax:
Mailing address:
  • Phone: 207-703-3958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LOREANA MONIQUE THOMAS
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 603-534-6719