Creekwood Trail Adult Foster Care Home

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

AS630277210 Issued in MI

Legal business name

CREEKWOOD TRAIL ADULT FOSTER CARE HOME

Practice address

10078 Creekwood Trail
Davisburg, MI 48350-2058

Phone

(248) 625-0869

Fax

(248) 620-9403

NPI assigned

Mar 17, 2010

Organization subpart

No

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

Authorized official

Name

Ms. Carolyn Ann Wilson

Title

Home Care Provider

Phone

(248) 625-0869

Specialties & licenses 1

Addresses

Other names 1

• Creekwood Trail Family Home Doing business as

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

{
    "created_epoch": "1268784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268784000000",
    "number": "1598089773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10078 CREEKWOOD TRL",
            "address_2": "240 O'RILEY COURT",
            "city": "DAVISBURG",
            "state": "MI",
            "postal_code": "483502058",
            "telephone_number": "248-625-0869",
            "fax_number": "248-620-9403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10078 CREEKWOOD TRAIL",
            "city": "DAVISBURG",
            "state": "MI",
            "postal_code": "483502058",
            "telephone_number": "248-625-0869",
            "fax_number": "248-620-9403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKWOOD TRAIL ADULT FOSTER CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-17",
        "last_updated": "2010-03-17",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "HOME CARE PROVIDER",
        "authorized_official_telephone_number": "248-625-0869",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MI",
            "license": "AS630277210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creekwood Trail Family Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Leigh Stewart Brewster, PH.D, M.S.W.
• Robert Allen Bringman, LMSW
• Jeffrey John Burdess
• Stacie Champeau
• Maureen Marie Tracy Christensen, RN
• David Tapani PLC
• Davisburg Dental Services LLC
• Dana Marie Decapite, LMSW
• Mark Allen Dennis, DDS
• Sara Dickie, LLMSW

• Exclusive Provider Organization in Davisburg, MI
• Providers in Davisburg, MI by specialty
• Exclusive Provider Organization in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2010; 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.