Provider Demographics
NPI:1811574833
Name:CREATIVE POTENTIAL LLC
Entity Type:Organization
Organization Name:CREATIVE POTENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIERRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-848-0514
Mailing Address - Street 1:1031 NORWICH NEW LONDON TPKE UNIT 10
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-1600
Mailing Address - Country:US
Mailing Address - Phone:860-848-0514
Mailing Address - Fax:860-848-0523
Practice Address - Street 1:1031 NORWICH NEW LONDON TPKE UNIT 10
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-1600
Practice Address - Country:US
Practice Address - Phone:860-848-0514
Practice Address - Fax:860-848-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health