MEDICARE: CREATIVE SUPPORTS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1598828147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE SUPPORTS, INC

Provider Business Mailing Address
First Line	:	PO BOX 10586
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64188-0586
Country	:	US
Telephone Number	:	816-452-6194
Fax Number	:	816-454-3211

Provider Business Practice Location Address
First Line	:	1511 NE PARVIN RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-2304
Country	:	US
Telephone Number	:	816-452-6194
Fax Number	:	816-454-3211

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. DANA LANICE GUYER
Credential	:
Telephone Number	:	816-452-6194

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/22/2020

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