| NPI | 1366563314 |
|---|---|
| Former Legal Business Name | CREATIVE CARE OPTIONS FDL COUNTY |
| Entity Type | Organization |
| Authorized Contact | KIM M MICKLE Compliance Manager 920-906-5100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2017-01-04 |