Provider Demographics
NPI:1497316715
Name:CENTER FOR CREATIVE VALUES
Entity Type:Organization
Organization Name:CENTER FOR CREATIVE VALUES
Other - Org Name:PROVIDENCE INTEGRATED HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR / CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ATOLOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-929-8315
Mailing Address - Street 1:515 E JOPPA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286-1804
Mailing Address - Country:US
Mailing Address - Phone:410-337-0938
Mailing Address - Fax:
Practice Address - Street 1:515 E JOPPA RD STE 100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-1804
Practice Address - Country:US
Practice Address - Phone:410-337-0938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR CREATIVE VALUES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-26
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, ChildrenGroup - Single Specialty