Provider Demographics
NPI:1437997723
Name:CREATIVE BRAINS HEALING HEARTS LLC
Entity type:Organization
Organization Name:CREATIVE BRAINS HEALING HEARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-466-0139
Mailing Address - Street 1:1866 E MARKET ST STE CPMB127
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-5111
Mailing Address - Country:US
Mailing Address - Phone:614-753-5965
Mailing Address - Fax:
Practice Address - Street 1:2015 RESERVOIR ST STE 202
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8722
Practice Address - Country:US
Practice Address - Phone:614-753-5965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)