Healthcare Provider Details

I. General information

NPI: 1063323111
Provider Name (Legal Business Name): CREATIVE LIVES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5314 LINDER PL
NEW PORT RICHEY FL
34652-3734
US

IV. Provider business mailing address

5314 LINDER PL
NEW PORT RICHEY FL
34652-3734
US

V. Phone/Fax

Practice location:
  • Phone: 813-406-3832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: GARPHARD BEAGUE
Title or Position: PRES
Credential:
Phone: 813-406-3832