Provider Demographics
NPI:1750142667
Name:CREATIVELY CHANGING LIVES INC
Entity type:Organization
Organization Name:CREATIVELY CHANGING LIVES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MITSCH
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-337-3526
Mailing Address - Street 1:5314 LINDER PL
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5000 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-5908
Practice Address - Country:US
Practice Address - Phone:727-337-3526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services