Healthcare Provider Details

I. General information

NPI: 1881748036
Provider Name (Legal Business Name): CREATIVE HEALTH CARE SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 EAGLES COVE CIR
NORTH PRAIRIE WI
53153-9628
US

IV. Provider business mailing address

221 EAGLES COVE CIR
NORTH PRAIRIE WI
53153-9628
US

V. Phone/Fax

Practice location:
  • Phone: 414-431-9411
  • Fax: 414-778-0242
Mailing address:
  • Phone: 414-431-9411
  • Fax: 414-778-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateWI

VIII. Authorized Official

Name: MS. MARSHA ANN SNYDER
Title or Position: PRESIDENT
Credential: M.S.W.
Phone: 414-431-9411