CREATIVE LIFE SKILLS DEVELOPMENT (NPI# 1184703670) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184703670 |
| Entity Type | Organization |
| Organization Name | CREATIVE LIFE SKILLS DEVELOPMENT |
| Practice Address |
15508 W Bell Rd Suite 101-261 Surprise AZ 85374-2432 |
| Practice Telephone | 6024415975 |
| Practice Fax Number | 6024858859 |
| Mailing Telephone | 6024415975 |
| Mailing Fax Number | 6024858859 |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2011-09-07 |
| Authorized Official Name | MRS. LISA LYN HERRMANN (OWNER) |
| Authorized Official Telephone | 6024415975 |
| Authorized Official Credential | M.S OTR/L |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2251P0200X |
Physical Therapist Specialization: Pediatrics |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 225XP0200X |
Occupational Therapist Specialization: Pediatrics |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 235Z00000X | Speech-Language Pathologist | Speech, Language and Hearing Service Providers | ||
| N | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2762 | AZ | Residential Treatment Facilities |
| Y | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities |
| Street Address |
15508 W BELL RD SUITE 101-261 |
| City | SURPRISE |
| State | AZ |
| Zip Code | 85374-2432 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396136347 | Samantha Boise | Specialist/Technologist | 15508 W Bell Rd, Suite 101-261, Surprise, AZ 85374-2432 | 2015-02-12 |
| 1942613690 | Kayla Lynn Flores | Specialist/Technologist | 15508 W Bell Rd, Ste 101-261, Surprise, AZ 85374-2432 | 2014-06-10 |
| 1386988723 | T.e.a.m. 4 Kids, LLC | Physical Therapist | 15508 W Bell Rd, Suite 101-261, Surprise, AZ 85374-2432 | 2012-11-26 |
| 1295083202 | Smiles By Delivery, Pllc | Dental Hygienist | 15508 W Bell Rd, 101-525, Surprise, AZ 85374-2432 | 2012-08-22 |
| 1033467113 | Elaine Carmella Mamola | Dental Hygienist | 15508 W Bell Rd, 101-525, Surprise, AZ 85374-2432 | 2012-08-21 |
| 1467779744 | Bhp, LLC | Psychologist | 15508 W Bell Rd, Surprise, AZ 85374-2432 | 2010-04-27 |
| 1770815565 | Christy Scheeler Lopez | Occupational Therapist | 15508 W Bell Rd, Ste 101-261, Surprise, AZ 85374-2432 | 2010-02-04 |
| 1215181672 | Darcie Lynn Bulger | Occupational Therapist | 15508 W Bell Rd, Suite 101-261, Surprise, AZ 85374-2432 | 2008-11-12 |
| 1093832024 | Charles W. Enouen | Chiropractor | 15508 W Bell Rd, Suite 105, Surprise, AZ 85374-2432 | 2007-03-23 |
| 1235296633 | Jenny V Wang | Dentist | 15508 W Bell Rd, Suite 110, Surprise, AZ 85374 | 2007-01-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225648801 | Jennilyn Joy Puhawan Cave | Emergency Medicine | 14440 W Tierra Buena Ln, Surprise, AZ 85374 | 2020-08-07 |
| 1912538497 | Dental Depot of Surprise, Pllc | Clinic/Center | 13828 W. Greenway Rd., Surprise, AZ 85374 | 2020-02-03 |
| 1447898622 | Vhs of Arrowhead, Inc. | General Acute Care Hospital | 16815 W. Bell Rd, Surprise, AZ 85374 | 2019-12-18 |
| 1073155834 | Regency Ambulatory Surgery Center One, LLC | Clinic/Center | 14753 W Mountain View Blvd, Surprise, AZ 85374 | 2019-10-14 |
| 1164064929 | Advanced Ambulatory Surgery Center One, LLC | Clinic/Center | 14753 W. Mountain View Blvd., Surprise, AZ 85374 | 2019-10-14 |
| 1275005308 | Filsan Ali | Nurse Practitioner | 14780 W Mountain View Blvd #109, Surprise, Az 85374, Surprise, AZ 85374 | 2018-12-31 |
| 1427528686 | Anna L Bell | Nurse Practitioner | 14811 W Bell Rd Ste 100, Surprise, AZ 85374 | 2018-11-30 |
| 1649755893 | Surprise Behavioral Hospital Lp | Psychiatric Hospital | 16561 North Parkview Place, Surprise, AZ 85374 | 2018-10-03 |
| 1336621259 | Chaparral Winds LLC | Assisted Living Facility | 16623 N West Point Parkway, Surprise, AZ 85374 | 2018-09-06 |
| 1104310648 | Austin Daniel Lau | Dentist | 17018 W Bell Rd, Surprise, AZ 85374 | 2018-06-19 |
| Find all providers in zip 85374 | ||||
| Taxonomy Code | 261QD1600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Developmental Disabilities |
| An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
| Notes: [7/1/2003: new] |
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|---|---|---|---|---|
| 1013486943 | Manes and Miracles | Clinic/Center | 43421 N Friend Ave, San Tan Valley, AZ 85140-9621 | 2018-11-21 |
| 1942606298 | Debra Jacobs Ma Otr | Clinic/Center | 5940 E Placita Alta Reposa, Tucson, AZ 85750-1058 | 2014-11-14 |
| 1740696673 | Arizona Behavior & Autism LLC | Clinic/Center | 4885 S Houghton Rd, A, Tucson, AZ 85730-5201 | 2014-07-11 |
| 1932107299 | Tender Touch Occupational Therapy Services, LLC | Clinic/Center | 8190 W Deer Valley Rd, #104-200, Peoria, AZ 85382-2126 | 2005-07-11 |
| 1427681949 | Future Forward Wellness | Clinic/Center | 3610 N 44th St, Ste 210, Phoenix, AZ 85018-6059 | 2020-02-13 |
| 1982236212 | Werx Organization, Inc. | Clinic/Center | 12725 W Indian School Rd, Suite E-101, Avondale, AZ 85392 | 2020-02-05 |
| 1073087961 | Next Step Psychology LLC | Clinic/Center | 1600 W Chandler Blvd Ste 220, Chandler, AZ 85224-6162 | 2019-01-14 |
| 1013467513 | Casa Grande Elementary School District | Clinic/Center | 220 W Kortsen Rd, Casa Grande, AZ 85122-5910 | 2016-10-07 |
| 1962784249 | Theracare Pllc | Clinic/Center | 9385 W Donald Dr, Peoria, AZ 85383-2988 | 2011-09-13 |
| 1255640488 | The Wellington-alexander, Inc. | Clinic/Center | 9821 E Bell Rd, Suite 100, Scottsdale, AZ 85260-2344 | 2010-10-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.