Provider Demographics
NPI:1700541984
Name:CREEKSIDE FAMILY CARE LLC
Entity Type:Organization
Organization Name:CREEKSIDE FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAQUET
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-301-3907
Mailing Address - Street 1:1345 W MASON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-2049
Mailing Address - Country:US
Mailing Address - Phone:920-301-3907
Mailing Address - Fax:920-391-5180
Practice Address - Street 1:1345 W MASON ST STE 202
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2049
Practice Address - Country:US
Practice Address - Phone:920-301-3907
Practice Address - Fax:920-391-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health