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General NPI Number Information
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NPI Number | 1669895454
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Entity Type | Organization
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Legal Business Name | CREATIVE CARE INC.
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 1127 SUNSET ST
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City | RICHLAND
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State | WA
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Zip | 99354-2434
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Country | US
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Telephone | 509-943-6292
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Fax | 509-946-5106
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Provider Business Mailing Address
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Address Line | 1604 JUDSON AVE
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City | RICHLAND
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State | WA
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Zip | 99354-2944
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Country | US
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Telephone | 509-460-1825
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Fax | 509-943-1196
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Authorized Official
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Title or Position | PRESIDENT
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Name | VALERIE FAYE JOHNSON
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Credential | RN00137531
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Telephone | 509-460-1825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 750575
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License Number State | WA
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