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General NPI Number Information
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NPI Number | 1154517480
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Entity Type | Organization
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Legal Business Name | CREATIVE LIVING CENTER
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 4748 STANTONSBURG RD
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City | GREENVILLE
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State | NC
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Zip | 27834-4794
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Country | US
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Telephone | 252-757-0147
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Fax | 252-757-0147
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Provider Business Mailing Address
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Address Line | PO BOX 948
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City | GREENVILLE
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State | NC
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Zip | 27835-0948
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Country | US
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Telephone | 252-757-0147
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Fax | 252-757-0147
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | CHRISTINA HARDY
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Credential |
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Telephone | 252-757-0147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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