Provider Demographics
NPI:1477792794
Name:CREATIVE CARE, INC.
Entity Type:Organization
Organization Name:CREATIVE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MORTEZA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALEGHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-589-9834
Mailing Address - Street 1:PO BOX 24595
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-0595
Mailing Address - Country:US
Mailing Address - Phone:310-589-9834
Mailing Address - Fax:310-774-5369
Practice Address - Street 1:5941 TRANCAS CANYON RD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3118
Practice Address - Country:US
Practice Address - Phone:310-589-9834
Practice Address - Fax:310-774-5369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190226CP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility