Provider Demographics
NPI:1003320169
Name:CREED INTEGRATED BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:CREED INTEGRATED BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:THE CREED OF RECOVERY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-404-6008
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:43155-0243
Mailing Address - Country:US
Mailing Address - Phone:614-404-6008
Mailing Address - Fax:
Practice Address - Street 1:551 1/2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3809
Practice Address - Country:US
Practice Address - Phone:614-404-6008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health