Provider Demographics
NPI:1114416344
Name:CREATIVE HOME CARE SOLUTIONS, INC.
Entity Type:Organization
Organization Name:CREATIVE HOME CARE SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEKEYSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYENUMELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-803-2908
Mailing Address - Street 1:PO BOX 2383
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-2383
Mailing Address - Country:US
Mailing Address - Phone:336-803-2908
Mailing Address - Fax:336-905-7311
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-9531
Practice Address - Country:US
Practice Address - Phone:336-781-0938
Practice Address - Fax:336-781-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 251J00000X, 253Z00000X
NCHC5013385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY ADMINISTRATION