Healthcare Provider Details

I. General information

NPI: 1053547240
Provider Name (Legal Business Name): CREATIVE CARE SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 N ROOP ST SUITE 211
CARSON CITY NV
89701-3113
US

IV. Provider business mailing address

800 N RAINBOW BLVD SUITE 208
LAS VEGAS NV
89107-1189
US

V. Phone/Fax

Practice location:
  • Phone: 775-884-1400
  • Fax: 775-884-1402
Mailing address:
  • Phone: 702-643-4443
  • Fax: 702-878-8761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROL J GRAHAM
Title or Position: PRESIDENT
Credential:
Phone: 702-643-4443