Provider Demographics
NPI:1174620314
Name:CREATE, INC.
Entity type:Organization
Organization Name:CREATE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PROGRAM OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-241-4070
Mailing Address - Street 1:760 E 160TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-7815
Mailing Address - Country:US
Mailing Address - Phone:718-401-5700
Mailing Address - Fax:718-993-5308
Practice Address - Street 1:73 MALCOLM X BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-3007
Practice Address - Country:US
Practice Address - Phone:212-663-1975
Practice Address - Fax:212-663-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY240610743OtherNYS OASAS OPERATING CERTIFICATE
NY01764878Medicaid