Organization Active NPI

Creative Community Service, Inc.

Community/Behavioral Health Agency
Norcross, GA

National Provider Identifier

1891820130

Registry record updated May 21, 2008

On this page

Key facts
NPPES NPI Registry
National Provider Directory
NPI Registry JSON
Other providers in Norcross, GA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Community/Behavioral Health AgencyTaxonomy code 251S00000X
License: 060-R-0018 Issued in GA
Legal business name: CREATIVE COMMUNITY SERVICE, INC.
Practice address: 4487 Park Dr
Suite a
Norcross, GA 30093-2964
Phone: (770) 469-6226
Fax: (678) 894-4081
NPI assigned: Feb 23, 2007
Organization subpart: No

NPPES NPI Registry

Updated by the provider on May 21, 2008

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

Authorized official

Name: Ms. Cathy Pallon
Title: Chief Operating Officer
Phone: (770) 469-6226

Specialties & licenses 3

Specialty (taxonomy)	Code	License	State	Primary
Developmentally Disabled Services Day Training Agency	251C00000X	060-R-0018	GA
Community/Behavioral Health Agency	251S00000X	060-R-0018	GA	Primary
Community/Behavioral Health Agency	251S00000X	CP-FC0040079	GA

Addresses

Primary practice location

4487 Park Dr
Suite a
Norcross, GA 30093-2964

Mailing address

4487 Park Dr
Suite a
Norcross, GA 30093-2964
Phone (770) 469-6226

Other identifiers 37

Identifier	Type	State
000565375AA	Medicaid	GA
000565375AC	Medicaid	GA
000565375F	Medicaid	GA
000565375G	Medicaid	GA
000565375J	Medicaid	GA
000565375Y	Medicaid	GA
000565375AD	Medicaid	GA
000565375AF	Medicaid	GA
000565375AL	Medicaid	GA
000565375AN	Medicaid	GA
000565375N	Medicaid	GA
000565375P	Medicaid	GA
000565375U	Medicaid	GA
000565375AB	Medicaid	GA
000565375AK	Medicaid	GA
000565375M	Medicaid	GA
000565375V	Medicaid	GA
000565375W	Medicaid	GA
000565375Z	Medicaid	GA
000565375L	Medicaid	GA
000565375Q	Medicaid	GA
000565375AM	Medicaid	GA
000565375I	Medicaid	GA
300025237-C	Medicaid	GA
000565375AE	Medicaid	GA
000565375AI	Medicaid	GA
000565375AJ	Medicaid	GA
000565375R	Medicaid	GA
000565375S	Medicaid	GA
000565375X	Medicaid	GA
000565375K	Medicaid	GA
000565375O	Medicaid	GA
000565375T	Medicaid	GA
000565375AG	Medicaid	GA
000565375AH	Medicaid	GA
000565375B	Medicaid	GA
000565375H	Medicaid	GA

National Provider Directory

Locations

4487 Park Dr
Ste A
Norcross, GA 30093
Phone (770) 469-6226

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1891820130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4487 PARK DR",
            "address_2": "SUITE A",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300932964",
            "telephone_number": "770-469-6226",
            "fax_number": "678-894-4081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4487 PARK DR",
            "address_2": "SUITE A",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300932964",
            "telephone_number": "770-469-6226",
            "fax_number": "678-894-4081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE COMMUNITY SERVICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "PALLON",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "770-469-6226",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "GA",
            "license": "060-R-0018",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "060-R-0018",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "CP-FC0040079",
            "primary": false
        }
    ],
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        },
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            "identifier": "000565375B",
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            "identifier": "000565375H",
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        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norcross, GA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; 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.