MEDICARE: CREATIVE HEALTH CARE SOLUTIONS, 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	3104A0625X	Assisted Living Facility (Mental Illness)		WI
2	3104A0630X	Assisted Living Facility (Behavioral Disturbances)		WI

General Provider Information

NPI Number	:	1881748036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE HEALTH CARE SOLUTIONS, INC.

Provider Business Mailing Address
First Line	:	221 EAGLES COVE CIR
Second Line	:
City	:	NORTH PRAIRIE
State	:	WI
Zip	:	53153-9628
Country	:	US
Telephone Number	:	414-431-9411
Fax Number	:	414-778-0242

Provider Business Practice Location Address
First Line	:	221 EAGLES COVE CIR
Second Line	:
City	:	NORTH PRAIRIE
State	:	WI
Zip	:	53153-9628
Country	:	US
Telephone Number	:	414-431-9411
Fax Number	:	414-778-0242

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARSHA ANN SNYDER
Credential	:	M.S.W.
Telephone Number	:	414-431-9411

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	06/02/2009

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