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General NPI Number Information
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NPI Number | 1366639767
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Entity Type | Organization
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Legal Business Name | CREEK VIEW MANOR
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 19977 E VIA DE ARBOLES
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City | QUEEN CREEK
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State | AZ
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Zip | 85242-5024
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Country | US
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Telephone | 480-888-1182
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Fax | 480-888-1181
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Provider Business Mailing Address
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Address Line | 19977 E VIA DE ARBOLES
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City | QUEEN CREEK
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State | AZ
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Zip | 85242-5024
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Country | US
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Telephone | 480-888-1182
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Fax | 480-888-1181
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MS. CHARLEEN LOUISE HAWKSLEY
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Credential |
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Telephone | 480-888-1182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ALH-4954
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License Number State | AZ
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