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General NPI Number Information
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NPI Number | 1831562842
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Entity Type | Organization
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Legal Business Name | CREATIVE LIVING COMMUNITY CARE, LLC
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 200 HIGH ST.
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City | WINDSOR
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State | CT
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Zip | 06095-1100
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Country | US
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Telephone | 860-640-0660
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Fax | 860-640-4836
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Provider Business Mailing Address
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Address Line | 200 HIGH ST.
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City | WINDSOR
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State | CT
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Zip | 06095-1100
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Country | US
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Telephone | 860-640-0660
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Fax | 860-640-4836
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CLEMENT POWNALL
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Credential |
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Telephone | 860-640-0660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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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Taxonomy #3
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HCA0000240
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License Number State | CT
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