1720645328 NPI number — CREATIVE CHILD AND FAMILY SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720645328 NPI number — CREATIVE CHILD AND FAMILY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREATIVE CHILD AND FAMILY SERVICES, INC.
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:
Provider Other Organization Name Type Code:
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:
1720645328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1655 E. 6TH STREET
Provider Second Line Business Mailing Address:
A-4 #102
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-548-2959
Provider Business Mailing Address Fax Number:
951-479-5169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7049 OHIO RIVER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTVALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-946-2398
Provider Business Practice Location Address Fax Number:
951-479-5169
Provider Enumeration Date:
05/20/2019

Additional Information

Authorized Official

Authorized Official Last Name:
TIMMONS
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
310-946-2398

Provider Taxonomy Codes

  • Taxonomy code: 207QA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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