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General NPI Number Information
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NPI Number | 1982309738
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Entity Type | Organization
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Legal Business Name | CREATIVE LIVING SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 134 EVERGREEN PL STE 600
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City | EAST ORANGE
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State | NJ
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Zip | 07018-2011
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Country | US
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Telephone | 862-252-6752
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Fax |
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Provider Business Mailing Address
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Address Line | 134 EVERGREEN PL STE 600
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City | EAST ORANGE
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State | NJ
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Zip | 07018-2011
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Country | US
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Telephone | 862-252-6752
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ROYLETA S FOSTER
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Credential |
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Telephone | 862-253-6722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management 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 | 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 #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care 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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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