Provider Demographics
NPI:1659707008
Name:CREATIVE-HEALING, LLC
Entity Type:Organization
Organization Name:CREATIVE-HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:808-561-5424
Mailing Address - Street 1:619 KAPAHULU AVE PH
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-3822
Mailing Address - Country:US
Mailing Address - Phone:808-561-5424
Mailing Address - Fax:
Practice Address - Street 1:619 KAPAHULU AVE PH
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-3822
Practice Address - Country:US
Practice Address - Phone:808-561-5424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN 1338261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health