Healthcare Provider Details

I. General information

NPI: 1659291953
Provider Name (Legal Business Name): A CREATIVE TRANSITION LIVING FACILITY 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 MAPLE AVE
BURLINGTON NC
27215-5934
US

IV. Provider business mailing address

505 MACGREGOR DR
BURLINGTON NC
27217-9296
US

V. Phone/Fax

Practice location:
  • Phone: 336-417-3751
  • Fax:
Mailing address:
  • Phone: 336-417-3751
  • 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: MS. NATALIA KAMILAH GONZALEZ
Title or Position: OWNER/ ADMINISTRATOR
Credential:
Phone: 336-417-3751