1083865372 NPI number — CREATIVE LIVING SOLUTIONS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083865372 NPI number — CREATIVE LIVING SOLUTIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREATIVE LIVING SOLUTIONS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083865372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 HOLIDAY DR
Provider Second Line Business Mailing Address:
#408
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70114-8202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-361-5277
Provider Business Mailing Address Fax Number:
504-361-5297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 HOLIDAY DR
Provider Second Line Business Practice Location Address:
#408
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70114-8202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-361-5277
Provider Business Practice Location Address Fax Number:
504-361-5297
Provider Enumeration Date:
10/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
D'ANA
Authorized Official Middle Name:
EVETTE
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
504-361-5277

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  15085 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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