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General NPI Number Information
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NPI Number | 1578795324
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Entity Type | Organization
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Legal Business Name | CREATIVE LIVING COMMUNITY SERVICES, LLC
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Dates
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Enumeration Date | 08/12/2009
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Last Update Date | 08/12/2009
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Provider Practice Location Address
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Address Line | 853 PARAPET RD
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City | CHESAPEAKE
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State | VA
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Zip | 23323-2419
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Country | US
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Telephone | 757-717-8806
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Fax |
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Provider Business Mailing Address
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Address Line | 3212 ARMISTEAD DR
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City | PORTSMOUTH
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State | VA
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Zip | 23704-6104
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/FOUNDER
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Name | JEAN WHITE
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Credential |
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Telephone | 757-717-8806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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License Number State |
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