Provider Demographics
NPI:1518346519
Name:CREATIVE HOME CARE INC
Entity Type:Organization
Organization Name:CREATIVE HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLAYLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:918-647-7829
Mailing Address - Street 1:26256 CAUGHRON RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:OK
Mailing Address - Zip Code:74932
Mailing Address - Country:US
Mailing Address - Phone:918-647-7829
Mailing Address - Fax:918-654-3020
Practice Address - Street 1:26256 CAUGHRON RD
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:OK
Practice Address - Zip Code:74932
Practice Address - Country:US
Practice Address - Phone:918-647-7829
Practice Address - Fax:918-654-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0111111111Medicare NSC