Provider Demographics
NPI:1972006286
Name:CREATIVE SENIOR IN HOME CARE SERVICE LLC
Entity Type:Organization
Organization Name:CREATIVE SENIOR IN HOME CARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-995-5574
Mailing Address - Street 1:6151 LAKE OSPREY DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8419
Mailing Address - Country:US
Mailing Address - Phone:941-373-1400
Mailing Address - Fax:941-373-1401
Practice Address - Street 1:6151 LAKE OSPREY DR FL 3
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8419
Practice Address - Country:US
Practice Address - Phone:941-373-1400
Practice Address - Fax:941-373-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health