Provider Demographics
NPI:1023677432
Name:CREATIVE COMMUNITY MENTAL HEALTH INC
Entity type:Organization
Organization Name:CREATIVE COMMUNITY MENTAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGAROLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-992-4008
Mailing Address - Street 1:381 N KROME AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6047
Mailing Address - Country:US
Mailing Address - Phone:786-601-9202
Mailing Address - Fax:786-668-6398
Practice Address - Street 1:381 N KROME AVE STE 206
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6047
Practice Address - Country:US
Practice Address - Phone:786-601-9202
Practice Address - Fax:786-668-6398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1023677432Medicaid