Provider Demographics
NPI:1124389010
Name:CREATIVE FAMILY SERVICE, LLC
Entity Type:Organization
Organization Name:CREATIVE FAMILY SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:COUNSELOR/CASE MANAG
Authorized Official - Phone:414-388-8293
Mailing Address - Street 1:4620 W CONCORDIA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-3350
Mailing Address - Country:US
Mailing Address - Phone:414-388-8293
Mailing Address - Fax:
Practice Address - Street 1:4222 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2500
Practice Address - Country:US
Practice Address - Phone:414-388-8293
Practice Address - Fax:414-249-4658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 253Z00000X, 302R00000X
WI16594-130261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No302R00000XManaged Care OrganizationsHealth Maintenance Organization