Provider Demographics
NPI:1295193043
Name:CREATIVE GROWTH GROUP INC
Entity Type:Organization
Organization Name:CREATIVE GROWTH GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-408-1520
Mailing Address - Street 1:12941 ROYAL GEORGE AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-5710
Mailing Address - Country:US
Mailing Address - Phone:813-408-1520
Mailing Address - Fax:
Practice Address - Street 1:12941 ROYAL GEORGE AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-5710
Practice Address - Country:US
Practice Address - Phone:813-408-1520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities