NPIMap

Organization Active NPI

Harborcreek Youth Services

  • Psychiatric Residential Treatment Facility
  • Harborcreek, PA
National Provider Identifier
1033230677
Registry record updated Mar 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
License
462760 Issued in PA
Legal business name
HARBORCREEK YOUTH SERVICES
Practice address
5712 Iroquois Avenue
Liberty House
Harborcreek, PA 16421-1009
Phone
(814) 899-7664
Fax
(814) 899-3075
NPI assigned
Apr 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. John D. Petulla, LSW
Title
Chief Executive Officer
Phone
(814) 899-7664

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X 462760 PA Primary

Addresses

Primary practice location

5712 Iroquois Avenue
Liberty House
Harborcreek, PA 16421-1009

Mailing address

5712 Iroquois Avenue
Liberty House
Harborcreek, PA 16421-1009
Phone (814) 899-7664

Other identifiers 1

IdentifierTypeStateIssuer
001410380 0019MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Harborcreek Youth Services14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553731200000",
    "number": "1033230677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5712 IROQUOIS AVENUE",
            "address_2": "LIBERTY HOUSE",
            "city": "HARBORCREEK",
            "state": "PA",
            "postal_code": "164211009",
            "telephone_number": "814-899-7664",
            "fax_number": "814-899-3075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5712 IROQUOIS AVENUE",
            "address_2": "LIBERTY HOUSE",
            "city": "HARBORCREEK",
            "state": "PA",
            "postal_code": "164211009",
            "telephone_number": "814-899-7664",
            "fax_number": "814-899-3075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBORCREEK YOUTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2019-03-28",
        "status": "A",
        "authorized_official_last_name": "PETULLA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "814-899-7664",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LSW"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "PA",
            "license": "462760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001410380 0019",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harborcreek, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.