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General NPI Number Information
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NPI Number | 1861128514
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Entity Type | Organization
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Legal Business Name | CREATIVE EDGE INNOVATIONS
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Dates
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Enumeration Date | 07/26/2022
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 7889 MILLWOOD DR
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City | WESTLAND
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State | MI
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Zip | 48185-1495
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Country | US
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Telephone | 313-920-7087
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Fax |
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Provider Business Mailing Address
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Address Line | 7889 MILLWOOD DR
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City | WESTLAND
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State | MI
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Zip | 48185-1495
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Country | US
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Telephone | 313-920-7087
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRENTON MICHAEL THORNTON
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Credential |
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Telephone | 313-920-7087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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