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General NPI Number Information
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NPI Number | 1588286074
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Entity Type | Organization
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Legal Business Name | CREATIVE INDEPENDENCE ALLIANCE, CORP.
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 05/07/2020
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Provider Practice Location Address
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Address Line | 5323 MILLENIA LK BLVD STE 300
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City | ORLANDO
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State | FL
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Zip | 32839-3395
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Country | US
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Telephone | 844-698-4498
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Fax |
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Provider Business Mailing Address
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Address Line | 5323 MILLENIA LK BLVD STE 300
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City | ORLANDO
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State | FL
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Zip | 32839-3395
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | PAMELA PENDLETON
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Credential |
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Telephone | 267-275-2393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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