Organization
CREATIVE CUSTOM LIVING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY A. ALLRED SR. (DIRECTOR)
(336) 674-7751
Entity
Organization
Contact information
Practice address
6010 DAVIS MILL RD, GREENSBORO, NC 27406-9129
(336) 674-7751
(336) 674-6336
Mailing address
PO BOX 638, PLEASANT GARDEN, NC 27313-0638
(336) 674-7751
(336) 674-6336
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
MHL-041-845
NC
Other
Enumeration date
01/01/2008
Last updated
01/02/2008
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