Provider Demographics
NPI:1053708735
Name:CREATOR ORIGINAL SERVICES INC
Entity type:Organization
Organization Name:CREATOR ORIGINAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-299-6563
Mailing Address - Street 1:6828 POMEROY CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6575
Mailing Address - Country:US
Mailing Address - Phone:321-299-6563
Mailing Address - Fax:407-641-8693
Practice Address - Street 1:6828 POMEROY CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6575
Practice Address - Country:US
Practice Address - Phone:321-299-6563
Practice Address - Fax:407-641-8693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230911253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL230911OtherAGENCY FOR HEALTH CARE ADMINISTRATION