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Home for Creative Living

Organization Active NPI Intellectual Disabilities Intermediate Care Facility · Windom, MN

NPI 1013072230 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1013072230
Entity type
Organization (NPI type 2)
Primary specialty
Intellectual Disabilities Intermediate Care Facility 315P00000X
License
809491-1-RS (MN)
Legal business name
HOME FOR CREATIVE LIVING
Practice address
108 9TH St
Windom, MN 56101-1746
Phone
(507) 831-5033
Fax
(507) 831-2612
NPI assigned
Dec 27, 2006
Organization subpart
No

Authorized official

Name
Mr. Devin Nelson, COO
Title
Chief Operating Officer
Phone
(507) 233-4400

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0405197Home for Creative Living
108 9TH Street, Windom, MN 56101		Certificate of waiverJul 21, 2027

National Provider Directory

Locations

220 Milwaukee St
Ste 2
Lakefield, MN 56150
Phone (507) 662-5236

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 809491-1-RS MN Yes

Addresses

Primary practice location

108 9TH St
Windom, MN 56101-1746

Mailing address

220 Milwaukee St Ste 2
Lakefield, MN 56150-9495
Phone (507) 662-5236

Other providers in Windom, MN

All providers in Windom, MN · Intellectual Disabilities Intermediate Care Facility in Minnesota

Sources for this page

Verify at the official NPI Registry.