NPIMap

Organization Active NPI

Creative Image Personal Care Service LLC

  • Respite Care
  • Indianola, MS
National Provider Identifier
1164964003
Registry record updated Nov 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Respite CareTaxonomy code 385H00000X
License
385H00000X-RESPITE Issued in MS
Legal business name
CREATIVE IMAGE PERSONAL CARE SERVICE LLC
Practice address
503 Highway 82 E
Indianola, MS 38751-2317
Phone
(662) 379-0238
Fax
(662) 887-8050
NPI assigned
Nov 9, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Chandra Rena Thomas
Title
Ceo/Owner
Phone
(662) 379-0238

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X 311ZA0620X-ADULTCARE
Respite Care 385H00000X 385H00000X-RESPITE MS Primary

Addresses

Primary practice location

503 Highway 82 E
Indianola, MS 38751-2317

Mailing address

216 French Rd
Indianola, MS 38751-9668
Phone (662) 379-0238

Other names 1

  • CREATIVE IMAGE RESPITE CARE SERVICE LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Creative Image Personal Care Service LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

503 Highway 82 E
Indianola, MS 38751
Phone (662) 379-0238

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478649600000",
    "number": "1164964003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 FRENCH RD",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387519668",
            "telephone_number": "662-379-0238",
            "fax_number": "662-887-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 HIGHWAY 82 E",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387512317",
            "telephone_number": "662-379-0238",
            "fax_number": "662-887-8050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE IMAGE PERSONAL CARE SERVICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-09",
        "last_updated": "2016-11-09",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "CHANDRA",
        "authorized_official_middle_name": "RENA",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "662-379-0238",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": "311ZA0620X-ADULTCARE",
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "MS",
            "license": "385H00000X-RESPITE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CREATIVE IMAGE RESPITE CARE SERVICE LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianola, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.