Provider Demographics
NPI:1114571320
Name:CREATIVE KIDS AFTER SCHOOL ENRICHMENT
Entity Type:Organization
Organization Name:CREATIVE KIDS AFTER SCHOOL ENRICHMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE-MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-428-4851
Mailing Address - Street 1:529 BLACK MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-5880
Mailing Address - Country:US
Mailing Address - Phone:980-428-4851
Mailing Address - Fax:
Practice Address - Street 1:529 BLACK MAPLE DR
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-5880
Practice Address - Country:US
Practice Address - Phone:980-428-4851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health