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General NPI Number Information
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NPI Number | 1659611788
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Entity Type | Organization
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Legal Business Name | CREATIVE LIVING CENTERS, INC
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Dates
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Enumeration Date | 02/27/2013
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 521 E BEACH DR
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City | PANAMA CITY
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State | FL
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Zip | 32401-3247
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Country | US
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Telephone | 850-763-3655
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Fax | 850-763-9048
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Provider Business Mailing Address
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Address Line | 521 E BEACH DR
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City | PANAMA CITY
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State | FL
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Zip | 32401-3247
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Country | US
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Telephone | 850-763-3655
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Fax | 850-763-9048
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. VERNA LAMORE CONNOR
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Credential |
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Telephone | 850-763-3655
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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 | AL5888
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 140191200
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | AL5888
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | AL5888
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License Number State | FL
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