Organization
CREATIVE COMMUNITY SERVICE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CATHY PALLON (CHIEF OPERATING OFFICER)
(770) 469-6226
Entity
Organization
Contact information
Practice address
4487 PARK DR, SUITE A, NORCROSS, GA 30093-2964
(770) 469-6226
(678) 894-4081
Mailing address
4487 PARK DR, SUITE A, NORCROSS, GA 30093-2964
(770) 469-6226
(678) 894-4081
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
060-R-0018
GA
251S00000X
Community/Behavioral Health Agency
Primary
060-R-0018
GA
251S00000X
Community/Behavioral Health Agency
CP-FC0040079
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000565375AA
—
GA
05
—
000565375AB
—
GA
05
—
000565375AC
—
GA
05
—
000565375AD
—
GA
05
—
000565375AE
—
GA
05
—
000565375AF
—
GA
05
—
000565375AG
—
GA
05
—
000565375AH
—
GA
05
—
000565375AI
—
GA
05
—
000565375AJ
—
GA
05
—
000565375AK
—
GA
05
—
000565375AL
—
GA
05
—
000565375AM
—
GA
05
—
000565375AN
—
GA
05
—
000565375B
—
GA
05
—
000565375F
—
GA
05
—
000565375G
—
GA
05
—
000565375H
—
GA
05
—
000565375I
—
GA
05
—
000565375J
—
GA
05
—
000565375K
—
GA
05
—
000565375L
—
GA
05
—
000565375M
—
GA
05
—
000565375N
—
GA
05
—
000565375O
—
GA
05
—
000565375P
—
GA
05
—
000565375Q
—
GA
05
—
000565375R
—
GA
05
—
000565375S
—
GA
05
—
000565375T
—
GA
05
—
000565375U
—
GA
05
—
000565375V
—
GA
05
—
000565375W
—
GA
05
—
000565375X
—
GA
05
—
000565375Y
—
GA
05
—
000565375Z
—
GA
05
—
300025237-C
—
GA
Enumeration date
02/23/2007
Last updated
05/21/2008
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