Provider Demographics
NPI:1255779989
Name:CREATIVE FAMILY SUPPORT
Entity type:Organization
Organization Name:CREATIVE FAMILY SUPPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRILLO- SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:714-619-9331
Mailing Address - Street 1:1851 E 1ST ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4017
Mailing Address - Country:US
Mailing Address - Phone:714-619-9331
Mailing Address - Fax:
Practice Address - Street 1:1851 E 1ST ST
Practice Address - Street 2:SUITE 900
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4017
Practice Address - Country:US
Practice Address - Phone:714-619-9331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-11635251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health