Provider Demographics
NPI:1659611788
Name:CREATIVE LIVING CENTERS, INC
Entity Type:Organization
Organization Name:CREATIVE LIVING CENTERS, INC
Other - Org Name:COVE MANOR RETIREMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERNA
Authorized Official - Middle Name:LAMORE
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-763-3655
Mailing Address - Street 1:521 E BEACH DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3247
Mailing Address - Country:US
Mailing Address - Phone:850-763-3655
Mailing Address - Fax:850-763-9048
Practice Address - Street 1:521 E BEACH DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3247
Practice Address - Country:US
Practice Address - Phone:850-763-3655
Practice Address - Fax:850-763-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5888310400000X, 3104A0625X, 311Z00000X
FL1401912003104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility