Provider Demographics
NPI:1013072230
Name:HOME FOR CREATIVE LIVING
Entity Type:Organization
Organization Name:HOME FOR CREATIVE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:507-233-4400
Mailing Address - Street 1:220 MILWAUKEE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LAKEFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:56150-9495
Mailing Address - Country:US
Mailing Address - Phone:507-662-5236
Mailing Address - Fax:507-662-5235
Practice Address - Street 1:108 9TH ST
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1746
Practice Address - Country:US
Practice Address - Phone:507-831-5033
Practice Address - Fax:507-831-2612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN809491-1-RS315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities