Provider Demographics
NPI:1447761713
Name:CELESTIAL HEALTH CREATIONS
Entity Type:Organization
Organization Name:CELESTIAL HEALTH CREATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARLISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMMP-CLT
Authorized Official - Phone:601-574-0985
Mailing Address - Street 1:7 LAKELAND CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5022
Mailing Address - Country:US
Mailing Address - Phone:601-326-2300
Mailing Address - Fax:601-345-3506
Practice Address - Street 1:7 LAKELAND CIR STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5022
Practice Address - Country:US
Practice Address - Phone:601-326-2300
Practice Address - Fax:601-345-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16951261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center