Healthcare Provider Details

I. General information

NPI: 1205962883
Provider Name (Legal Business Name): CREATIVE WORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SPEIRS ST
WESTBROOK ME
04092
US

IV. Provider business mailing address

10 SPEIRS ST
WESTBROOK ME
04092-4122
US

V. Phone/Fax

Practice location:
  • Phone: 207-879-1140
  • Fax: 207-879-1146
Mailing address:
  • Phone: 207-879-1140
  • Fax: 207-879-1146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number10425300
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number104250100
License Number StateME

VIII. Authorized Official

Name: JAMES FLAKER
Title or Position: CFO
Credential:
Phone: 207-879-1140