Provider Demographics
NPI:1720645328
Name:CREATIVE CHILD AND FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:CREATIVE CHILD AND FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-946-2398
Mailing Address - Street 1:1655 E. 6TH STREET
Mailing Address - Street 2:A-4 #102
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879
Mailing Address - Country:US
Mailing Address - Phone:909-548-2959
Mailing Address - Fax:951-479-5169
Practice Address - Street 1:7049 OHIO RIVER DR
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752
Practice Address - Country:US
Practice Address - Phone:310-946-2398
Practice Address - Fax:951-479-5169
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREATIVE CHILD AND FAMILY SERVICES, IN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty