Provider Demographics
NPI:1821655507
Name:CREATIVE LIFESTYLES HOME CARE INC
Entity Type:Organization
Organization Name:CREATIVE LIFESTYLES HOME CARE INC
Other - Org Name:MONTIANO RESIDENTIAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLAREL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-758-9539
Mailing Address - Street 1:1022 W FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-2442
Mailing Address - Country:US
Mailing Address - Phone:323-758-9539
Mailing Address - Fax:
Practice Address - Street 1:1022 W FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-2442
Practice Address - Country:US
Practice Address - Phone:323-758-9539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities