1326160698 NPI number — CREATIVE HUMAN SOLUTIONS, LLC

Table of content: (NPI 1326160698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326160698 NPI number — CREATIVE HUMAN SOLUTIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREATIVE HUMAN SOLUTIONS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LYSSA DANEHY, LISW
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326160698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11516
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAINBRIDGE ISLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98110-5516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-463-2685
Provider Business Mailing Address Fax Number:
866-531-2893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8270 NE BLAKELY HEIGHTS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAINBRIDGE ISLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98110-2298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-463-2685
Provider Business Practice Location Address Fax Number:
866-531-2893
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DANEHY
Authorized Official First Name:
LYSSA
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
505-463-2685

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  I-4133 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 68338287 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326160698 . This is a "OPTUMHEALTH" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 22051 . This is a "HSN CREDENTIALLING & VERI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 1669445367 . This is a "TRICARE/TRIWEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202004178 . This is a "PRESBYTARIAN HEALTH PLAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 802588000 . This is a "MAGELLAN INSURANCE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM202639 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326160698 . This is a "BC/BS NM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95266 . This is a "LOVELACE INSURANCE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 1669445367 . This is a "GEHA" identifier . This identifiers is of the category "OTHER".




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