MEDICARE: CREATIVE HEALTH SOLUTIONS

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	PTA4054	MS

General Provider Information

NPI Number	:	1386940666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE HEALTH SOLUTIONS

Provider Business Mailing Address
First Line	:	3125 HIGHWAY 50 E
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39702-9535
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3125 HIGHWAY 50 E
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39702-9535
Country	:	US
Telephone Number	:	662-574-1664
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST ASSISTANT
Name	:	MS. JENNIFER JEAN VEGA
Credential	:
Telephone Number	:	662-574-1664

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	02/02/2011

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Directions to “CREATIVE HEALTH SOLUTIONS ” Practice Location

Language	Start Address	Practice Location

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