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General NPI Number Information
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NPI Number | 1205962883
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Entity Type | Organization
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Legal Business Name | CREATIVE WORKS
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 10 SPEIRS ST
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City | WESTBROOK
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State | ME
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Zip | 04092
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Country | US
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Telephone | 207-879-1140
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Fax | 207-879-1146
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Provider Business Mailing Address
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Address Line | 10 SPEIRS ST
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City | WESTBROOK
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State | ME
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Zip | 04092-4122
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Country | US
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Telephone | 207-879-1140
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Fax | 207-879-1146
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Authorized Official
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Title or Position | CFO
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Name | JAMES FLAKER
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Credential |
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Telephone | 207-879-1140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 10425300
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 104250100
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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