Provider Demographics
NPI:1366639767
Name:CREEK VIEW MANOR
Entity Type:Organization
Organization Name:CREEK VIEW MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLEEN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HAWKSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-888-1182
Mailing Address - Street 1:19977 E VIA DE ARBOLES
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-5024
Mailing Address - Country:US
Mailing Address - Phone:480-888-1182
Mailing Address - Fax:480-888-1181
Practice Address - Street 1:19977 E VIA DE ARBOLES
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-5024
Practice Address - Country:US
Practice Address - Phone:480-888-1182
Practice Address - Fax:480-888-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-4954310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ923947OtherARIZONA LONG TERM CARE