Provider Demographics
NPI:1114388626
Name:OAKWOOD CREATIVE CARE INC.
Entity Type:Organization
Organization Name:OAKWOOD CREATIVE CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-464-1061
Mailing Address - Street 1:6915 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-8229
Mailing Address - Country:US
Mailing Address - Phone:480-464-1061
Mailing Address - Fax:480-464-1166
Practice Address - Street 1:247 N MACDONALD
Practice Address - Street 2:102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6622
Practice Address - Country:US
Practice Address - Phone:480-464-1061
Practice Address - Fax:480-464-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X, 225X00000X
AZAL0164D261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty