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Organization
CREEKSIDE PLACE, INC.
Active
Organization
CREEKSIDE PLACE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PUJA BORSO OTR/L, CLT, CAPS (ADMINISTRATOR)
(248) 346-4515
Entity
Organization
Contact information
Practice address
7251 N BRIARCLIFF KNOLL DR, WEST BLOOMFIELD, MI 48322-4049
(877) 327-5484
(248) 250-5999
Mailing address
2995 WEIDEMANN DR, CLARKSTON, MI 48348-1249
(248) 346-4515
(248) 250-5999
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AS630397523
LICENSE NUMBER
MI
Enumeration date
07/08/2020
Last updated
07/08/2020
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