Provider Demographics
NPI:1679801369
Name:CREIGHTOR, INC
Entity Type:Organization
Organization Name:CREIGHTOR, INC
Other - Org Name:VISITING ANGELS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POLNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-437-9500
Mailing Address - Street 1:1500 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE #209
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-7969
Mailing Address - Country:US
Mailing Address - Phone:325-437-9500
Mailing Address - Fax:325-437-9501
Practice Address - Street 1:1500 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE #209
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-7969
Practice Address - Country:US
Practice Address - Phone:325-437-9500
Practice Address - Fax:325-437-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011817253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care