Provider Demographics
NPI:1861128514
Name:CREATIVE EDGE INNOVATIONS
Entity type:Organization
Organization Name:CREATIVE EDGE INNOVATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENTON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-920-7087
Mailing Address - Street 1:7889 MILLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1495
Mailing Address - Country:US
Mailing Address - Phone:313-920-7087
Mailing Address - Fax:
Practice Address - Street 1:7889 MILLWOOD DR
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1495
Practice Address - Country:US
Practice Address - Phone:313-920-7087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREATIVE EDGE INNOVATIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies