Provider Demographics
NPI:1740850437
Name:CREATIVE LIFESTYLES
Entity type:Organization
Organization Name:CREATIVE LIFESTYLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:661-809-6077
Mailing Address - Street 1:PO BOX 191154
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-9154
Mailing Address - Country:US
Mailing Address - Phone:661-809-6077
Mailing Address - Fax:
Practice Address - Street 1:1832 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-6224
Practice Address - Country:US
Practice Address - Phone:323-737-2310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility