MEDICARE: CREATIVE NETWORKS

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	253Z00000X	In Home Supportive Care Agency		AZ

General Provider Information

NPI Number	:	1588814206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE NETWORKS

Provider Business Mailing Address
First Line	:	9901 LINN STATION RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-3808
Country	:	US
Telephone Number	:	800-866-0860
Fax Number	:

Provider Business Practice Location Address
First Line	:	4570 N ORACLE RD
Second Line	:	SUITE 144
City	:	TUCSON
State	:	AZ
Zip	:	85705-1638
Country	:	US
Telephone Number	:	520-323-4393
Fax Number	:	520-319-6274

Authorized Official
Title or Position	:	PRIVACY OFFICER
Name	:	DEENA OMBRES
Credential	:
Telephone Number	:	502-394-2387

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	09/30/2008

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