Healthcare Provider Details

I. General information

NPI: 1588890875
Provider Name (Legal Business Name): CREATIVE THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 SOUTHERN BLVD SE STE 133
RIO RANCHO NM
87124-3751
US

IV. Provider business mailing address

2003 SOUTHERN BLVD SE STE 133
RIO RANCHO NM
87124-3751
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-3999
  • Fax: 505-821-7671
Mailing address:
  • Phone: 505-891-3999
  • Fax: 505-821-7671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1795
License Number StateNM

VIII. Authorized Official

Name: MRS. HOLLYE ANN KOZLOWSKI
Title or Position: OWNER/MANAGER
Credential: OTR/L
Phone: 505-891-3999