Provider Demographics
NPI:1821232141
Name:C.R.E. ENTERPRISE, INC.
Entity Type:Organization
Organization Name:C.R.E. ENTERPRISE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:BALATBAT
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RNBSN
Authorized Official - Phone:650-340-0025
Mailing Address - Street 1:2012 SHOREVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3414
Mailing Address - Country:US
Mailing Address - Phone:650-348-3487
Mailing Address - Fax:
Practice Address - Street 1:2012 SHOREVIEW AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3414
Practice Address - Country:US
Practice Address - Phone:650-348-3487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities