Provider Demographics
NPI:1366102410
Name:CREATIONS OF CARE HOME CARE LLC.
Entity type:Organization
Organization Name:CREATIONS OF CARE HOME CARE LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-641-7561
Mailing Address - Street 1:930 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3816
Mailing Address - Country:US
Mailing Address - Phone:228-641-7561
Mailing Address - Fax:
Practice Address - Street 1:2434 PASS RD # D-13
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2121
Practice Address - Country:US
Practice Address - Phone:228-641-7561
Practice Address - Fax:844-836-2419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSHOMECAREOtherHOME CARE
MS832468397OtherPHLEBOTOMY