Provider Demographics
NPI:1043990666
Name:JCREATIVE3000
Entity type:Organization
Organization Name:JCREATIVE3000
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPROLES
Authorized Official - Suffix:
Authorized Official - Credentials:AAS
Authorized Official - Phone:586-625-9704
Mailing Address - Street 1:3201 S EDSEL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48217-2405
Mailing Address - Country:US
Mailing Address - Phone:586-625-9704
Mailing Address - Fax:
Practice Address - Street 1:3201 S EDSEL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48217-2405
Practice Address - Country:US
Practice Address - Phone:586-625-9704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty