Provider Demographics
NPI:1417014929
Name:CREATIVE MINDS ADULTS DAY HABILITATION SERVICES
Entity Type:Organization
Organization Name:CREATIVE MINDS ADULTS DAY HABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-352-5129
Mailing Address - Street 1:4670 TURPIN SQ
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6354
Mailing Address - Country:US
Mailing Address - Phone:614-352-5129
Mailing Address - Fax:
Practice Address - Street 1:4670 TURPIN SQ
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-6354
Practice Address - Country:US
Practice Address - Phone:614-352-5129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services