Provider Demographics
NPI:1477365310
Name:CREATIVE ADVENTURE THERAPY SERVICES
Entity type:Organization
Organization Name:CREATIVE ADVENTURE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:954-608-1957
Mailing Address - Street 1:3900 NE 18TH AVE APT 1603
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-9212
Mailing Address - Country:US
Mailing Address - Phone:954-608-1957
Mailing Address - Fax:
Practice Address - Street 1:3900 NE 18TH AVE APT 1603
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-9212
Practice Address - Country:US
Practice Address - Phone:954-608-1957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1336663731Medicaid