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General NPI Number Information
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NPI Number | 1669749057
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Entity Type | Organization
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Legal Business Name | CREATIVE CARE, LLC
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 917 S MERRIMAN RD
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City | WESTLAND
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State | MI
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Zip | 48186-4951
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Country | US
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Telephone | 734-344-0069
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Fax | 734-398-1271
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Provider Business Mailing Address
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Address Line | 917 S MERRIMAN RD
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City | WESTLAND
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State | MI
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Zip | 48186-4951
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Country | US
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Telephone | 734-344-0069
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARMAN ANDINO
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Credential |
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Telephone | 734-895-6506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801089395
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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