Organization
HOME FOR CREATIVE LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEVIN NELSON COO (CHIEF OPERATING OFFICER)
(507) 233-4400
Entity
Organization
Contact information
Practice address
108 9TH ST, WINDOM, MN 56101-1746
(507) 831-5033
(507) 831-2612
Mailing address
220 MILWAUKEE ST STE 2, LAKEFIELD, MN 56150-9495
(507) 662-5236
(507) 662-5235
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
809491-1-RS
MN
Other
Enumeration date
12/27/2006
Last updated
08/22/2020
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