Provider Demographics
NPI:1548596158
Name:CREATEHEALTH LLC
Entity Type:Organization
Organization Name:CREATEHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EJIKEME
Authorized Official - Middle Name:UCHENNA
Authorized Official - Last Name:NWOKOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-469-3678
Mailing Address - Street 1:3960 KNIGHT ARNOLD RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3035
Mailing Address - Country:US
Mailing Address - Phone:318-469-3678
Mailing Address - Fax:
Practice Address - Street 1:3960 KNIGHT ARNOLD RD
Practice Address - Street 2:SUITE 302
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3035
Practice Address - Country:US
Practice Address - Phone:318-469-3678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40592261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care