MEDICARE: CREATING OPTIONS LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1740329143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATING OPTIONS LLC

Provider Business Mailing Address
First Line	:	PO BOX 1083
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-1083
Country	:	US
Telephone Number	:	208-587-8095
Fax Number	:	208-587-8025

Provider Business Practice Location Address
First Line	:	2390 AMERICAN LEGION BLVD
Second Line	:	SUITE 2
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-3109
Country	:	US
Telephone Number	:	208-587-8095
Fax Number	:	208-587-8025

Authorized Official
Title or Position	:	AGENCY DIRECTOR
Name	:	STEPHAN RILEY
Credential	:	BA
Telephone Number	:	208-587-8095

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	08/22/2020

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Directions to “CREATING OPTIONS LLC ” Practice Location

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