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General NPI Number Information
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NPI Number | 1184401655
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Entity Type | Organization
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Legal Business Name | CREATIVE RESTORATIONS, INC
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 40 GARDENVILLE PKWY W STE 101
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City | WEST SENECA
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State | NY
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Zip | 14224-1387
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Country | US
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Telephone | 716-324-5255
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Fax |
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Provider Business Mailing Address
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Address Line | 190 DEAN RD
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City | DEPEW
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State | NY
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Zip | 14043-1308
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Country | US
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Telephone | 716-553-4886
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/PRESIDENT/TREASURER
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Name | CHRIS ALLEN HARZYNSKI
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Credential | CASAC-T/CRPA-P
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Telephone | 716-553-4886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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