Provider Demographics
NPI:1598801938
Name:CREATIVE CARE RESORCES
Entity Type:Organization
Organization Name:CREATIVE CARE RESORCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:BRENNAN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-432-7710
Mailing Address - Street 1:14985 GLAZIER AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7484
Mailing Address - Country:US
Mailing Address - Phone:952-432-7710
Mailing Address - Fax:952-432-5360
Practice Address - Street 1:14985 GLAZIER AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7484
Practice Address - Country:US
Practice Address - Phone:952-432-7710
Practice Address - Fax:952-432-5360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1009412-4-WS101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty