Provider Demographics
NPI:1326580713
Name:CREATIVE ENDINGS SOCIAL SERVICES, LLC
Entity Type:Organization
Organization Name:CREATIVE ENDINGS SOCIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:III
Authorized Official - Credentials:JD
Authorized Official - Phone:317-622-4104
Mailing Address - Street 1:4165 MILLERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2989
Mailing Address - Country:US
Mailing Address - Phone:317-622-4104
Mailing Address - Fax:317-737-2320
Practice Address - Street 1:4165 MILLERSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2989
Practice Address - Country:US
Practice Address - Phone:317-622-4104
Practice Address - Fax:317-737-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251B00000X, 251C00000X, 251S00000X
252Y00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)