Provider Demographics
NPI:1063247336
Name:CREATIVE LIVING SERVICES
Entity type:Organization
Organization Name:CREATIVE LIVING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-461-1524
Mailing Address - Street 1:920 PINTAIL CT
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-8173
Mailing Address - Country:US
Mailing Address - Phone:406-461-1524
Mailing Address - Fax:
Practice Address - Street 1:3000 VILLARD AVE TRLR 114
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-0472
Practice Address - Country:US
Practice Address - Phone:406-461-1524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health