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NPI Code Detail

MEDICARE: CREATIVE LIFESTYLES HOME CARE INC

MEDICARE: CREATIVE LIFESTYLES HOME CARE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320600000XIntellectual and/or Developmental Disabilities Residential Treatment Facility
2310400000XAssisted Living Facility

General Provider Information

NPI Number : 1821655507
Entity Type Code : Organization
Provider Name (Legal Business Name) : CREATIVE LIFESTYLES HOME CARE INC
Provider Business Mailing Address
First Line : 1022 W FLORENCE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-2442
Country : US
Telephone Number : 323-758-9539
Fax Number :
Provider Business Practice Location Address
First Line : 1022 W FLORENCE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-2442
Country : US
Telephone Number : 323-758-9539
Fax Number :
Authorized Official
Title or Position : CEO
Name : CLAREL MARTINE
Credential :
Telephone Number : 323-758-9539
Provider Enumeration Date : 05/28/2019
Last Update Date : 06/26/2021

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