Provider Demographics
NPI:1609045608
Name:CREATIVE GROWTH
Entity Type:Organization
Organization Name:CREATIVE GROWTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BORDAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-361-8053
Mailing Address - Street 1:9695 WASHINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-6094
Mailing Address - Country:US
Mailing Address - Phone:678-361-8053
Mailing Address - Fax:678-479-0293
Practice Address - Street 1:9695 WASHINGTON CIR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-6094
Practice Address - Country:US
Practice Address - Phone:678-361-8053
Practice Address - Fax:678-479-0293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities