MEDICARE: FRIENDS OF CREATIVEKIDS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	123153	TX

General Provider Information

NPI Number	:	1225288103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIENDS OF CREATIVEKIDS, INC.

Provider Business Mailing Address
First Line	:	12623 BETHANY BAY DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7867
Country	:	US
Telephone Number	:	713-429-3631
Fax Number	:	866-466-4320

Provider Business Practice Location Address
First Line	:	6702 INDIAN LAKE DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77489-2635
Country	:	US
Telephone Number	:	713-429-3631
Fax Number	:	866-466-4320

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MRS. TAMIKA JOY HIGGINS
Credential	:
Telephone Number	:	713-429-3631

Provider Enumeration Date	:	09/26/2008
Last Update Date	:	09/26/2008

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