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General NPI Number Information
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NPI Number | 1255779989
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Entity Type | Organization
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Legal Business Name | CREATIVE FAMILY SUPPORT
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 04/08/2014
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Provider Practice Location Address
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Address Line | 1851 E 1ST ST SUITE 900
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City | SANTA ANA
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State | CA
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Zip | 92705-4017
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Country | US
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Telephone | 714-619-9331
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Fax |
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Provider Business Mailing Address
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Address Line | 1851 E 1ST ST SUITE 900
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City | SANTA ANA
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State | CA
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Zip | 92705-4017
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Country | US
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Telephone | 714-619-9331
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KELLIE GRILLO- SCHMIDT
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Credential | MA
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Telephone | 714-619-9331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1-12-11635
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License Number State | CA
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