Healthcare Provider Details

I. General information

NPI: 1003117755
Provider Name (Legal Business Name): CREATING EMPOWERMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4773 MADRID RIDGE CT
LAS VEGAS NV
89129-3682
US

IV. Provider business mailing address

4773 MADRID RIDGE CT
LAS VEGAS NV
89129-3682
US

V. Phone/Fax

Practice location:
  • Phone: 702-656-9890
  • Fax: 702-656-9152
Mailing address:
  • Phone: 702-656-9890
  • Fax: 702-656-9152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATRICIA D DAVIS
Title or Position: PRESIDENT
Credential:
Phone: 702-656-9890