Healthcare Provider Details

I. General information

NPI: 1033652904
Provider Name (Legal Business Name): CREATIVE HOUSING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 CITYGATE DR
COLUMBUS OH
43219-3564
US

IV. Provider business mailing address

2233 CITYGATE DR
COLUMBUS OH
43219-3564
US

V. Phone/Fax

Practice location:
  • Phone: 614-418-7725
  • Fax: 614-418-7720
Mailing address:
  • Phone: 614-418-7725
  • Fax: 614-418-7720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. CRISTY BUENCONSEJO
Title or Position: DIRECTOR OF PROJECTS & DESIGN
Credential:
Phone: 614-418-7725