Provider Demographics
NPI:1134802937
Name:KREATIVE MINDS DIRECT CARE LLC
Entity type:Organization
Organization Name:KREATIVE MINDS DIRECT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-600-5249
Mailing Address - Street 1:252 WASHINGTON ST STE B3
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7582
Mailing Address - Country:US
Mailing Address - Phone:732-600-5249
Mailing Address - Fax:
Practice Address - Street 1:252 WASHINGTON ST STE B3
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7582
Practice Address - Country:US
Practice Address - Phone:732-333-3798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care