Healthcare Provider Details

I. General information

NPI: 1619488434
Provider Name (Legal Business Name): CREATIVE DIALOGUES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 RENIER AVE
TURTLE CREEK PA
15145-1608
US

IV. Provider business mailing address

828 RENIER AVE
TURTLE CREEK PA
15145-1608
US

V. Phone/Fax

Practice location:
  • Phone: 412-552-8145
  • Fax:
Mailing address:
  • Phone: 412-552-8145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberCER-00117686
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. TIMOTHY JONES
Title or Position: CHIEF EXECUTIVE
Credential:
Phone: 412-552-8145