Provider Demographics
NPI:1154517480
Name:CREATIVE LIVING CENTER
Entity type:Organization
Organization Name:CREATIVE LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-757-0147
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-0948
Mailing Address - Country:US
Mailing Address - Phone:252-757-0147
Mailing Address - Fax:252-757-0147
Practice Address - Street 1:4748 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4794
Practice Address - Country:US
Practice Address - Phone:252-757-0147
Practice Address - Fax:252-757-0147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC261QA0600XOtherADULT DAY CARE
NC3409016Medicaid