Provider Demographics
NPI:1336474790
Name:NEW CREATION SERVICES FOR CHILDREN / ADULTS, INC.
Entity Type:Organization
Organization Name:NEW CREATION SERVICES FOR CHILDREN / ADULTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:MCCRAY
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-730-1585
Mailing Address - Street 1:210 BRIGGE ST.
Mailing Address - Street 2:SUITE 113
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-0000
Mailing Address - Country:US
Mailing Address - Phone:919-730-1585
Mailing Address - Fax:
Practice Address - Street 1:210 BRIGGE ST.
Practice Address - Street 2:SUITE 113
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-0000
Practice Address - Country:US
Practice Address - Phone:919-730-1585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health