Provider Demographics
NPI:1497579569
Name:CUSTOM CREATIONS, LLC
Entity type:Organization
Organization Name:CUSTOM CREATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-897-5040
Mailing Address - Street 1:3090 N GOLIAD ST STE 102-817
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-7007
Mailing Address - Country:US
Mailing Address - Phone:469-897-5040
Mailing Address - Fax:
Practice Address - Street 1:5701 PRESIDENT GEORGE BUSH HWY STE 104
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-3691
Practice Address - Country:US
Practice Address - Phone:469-897-5040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier