Provider Demographics
NPI:1366563637
Name:CREATING UNLIMITED POSSIBILITIES
Entity type:Organization
Organization Name:CREATING UNLIMITED POSSIBILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:REEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-829-2613
Mailing Address - Street 1:159 SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-1445
Mailing Address - Country:US
Mailing Address - Phone:570-829-2613
Mailing Address - Fax:570-829-5166
Practice Address - Street 1:159 SIMPSON ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-1445
Practice Address - Country:US
Practice Address - Phone:570-829-2613
Practice Address - Fax:570-829-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA212370251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100003462 0003Medicaid