Provider Demographics
NPI:1609421163
Name:CREATIVE CONNECTIONS LLC
Entity Type:Organization
Organization Name:CREATIVE CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:MARTINEZ
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-252-6250
Mailing Address - Street 1:110 ELMWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-5117
Mailing Address - Country:US
Mailing Address - Phone:276-252-6250
Mailing Address - Fax:
Practice Address - Street 1:110 ELMWOOD CIR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-5117
Practice Address - Country:US
Practice Address - Phone:276-252-6250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)