# CREEKSIDE FAMILY CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700541984
- **Authorized official:** DAQUET REED (OWNER/ADMINISTRATOR)
- **Authorized official phone:** (920) 301-3907

## Contact information

- **Practice address:** 1345 W MASON ST STE 202, GREEN BAY, WI 54303-2049
- **Practice address phone:** (920) 301-3907
- **Practice address fax:** (920) 391-5180
- **Mailing address:** 1345 W MASON ST STE 202, GREEN BAY, WI 54303-2049
- **Mailing address phone:** (920) 301-3907
- **Mailing address fax:** (920) 391-5180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 11/03/2021
- **Last updated:** 11/03/2021