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General NPI Number Information
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NPI Number | 1124389010
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Entity Type | Organization
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Legal Business Name | CREATIVE FAMILY SERVICE, LLC
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 05/01/2015
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Provider Practice Location Address
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Address Line | 4222 W CAPITOL DR
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City | MILWAUKEE
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State | WI
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Zip | 53216-2500
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Country | US
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Telephone | 414-388-8293
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Fax | 414-249-4658
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Provider Business Mailing Address
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Address Line | 4620 W CONCORDIA AVE
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City | MILWAUKEE
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State | WI
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Zip | 53216-3350
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Country | US
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Telephone | 414-388-8293
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ANDREA WARD
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Credential | COUNSELOR/CASE MANAG
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Telephone | 414-388-8293
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 16594-130
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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