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General NPI Number Information
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NPI Number | 1053708735
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Entity Type | Organization
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Legal Business Name | CREATOR ORIGINAL SERVICES INC
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 6828 POMEROY CIR
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City | ORLANDO
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State | FL
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Zip | 32810-6575
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Country | US
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Telephone | 321-299-6563
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Fax | 407-641-8693
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Provider Business Mailing Address
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Address Line | 6828 POMEROY CIR
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City | ORLANDO
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State | FL
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Zip | 32810-6575
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Country | US
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Telephone | 321-299-6563
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Fax | 407-641-8693
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Authorized Official
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Title or Position | PRESIDENT
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Name | AUDREY R RICHARDS
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Credential |
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Telephone | 321-299-6563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 230911
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License Number State | FL
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