Provider Demographics
NPI:1194335430
Name:CREATIVE ALTERNATIVE FOR LEARNING & LIVING, INC.
Entity type:Organization
Organization Name:CREATIVE ALTERNATIVE FOR LEARNING & LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTORS PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-423-4818
Mailing Address - Street 1:11700 VIEJO CAMINO
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-6023
Mailing Address - Country:US
Mailing Address - Phone:805-466-0766
Mailing Address - Fax:805-466-8614
Practice Address - Street 1:11700 VIEJO CAMINO
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-6023
Practice Address - Country:US
Practice Address - Phone:805-466-0766
Practice Address - Fax:805-466-8614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA405800333OtherFACILITY #
CA405800568OtherFACILITY #
CA405800061OtherFACILITY #
CA405800130OtherFACILITY #
CA405801701OtherFACILITY #
CA405802280OtherFACILITY #