NPIMap

Organization Active NPI

Harborcreek Youth Services

  • Psychiatric Residential Treatment Facility
  • Erie, PA
National Provider Identifier
1386765923
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
License
433390 Issued in PA
Legal business name
HARBORCREEK YOUTH SERVICES
Practice address
3120 Peach St
McCormick House
Erie, PA 16508-2734
Phone
(814) 459-2212
Fax
(814) 874-3492
NPI assigned
Apr 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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 433390 PA Primary

Addresses

Primary practice location

3120 Peach St
McCormick House
Erie, PA 16508-2734

Mailing address

5712 Iroquois Ave
Harborcreek, PA 16421-1009
Phone (814) 899-7664

Other identifiers 1

IdentifierTypeStateIssuer
001410380 0016MedicaidPA

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

Locations

3120 Peach St
Erie, PA 16508
Phone (814) 459-2212

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": "1598054400000",
    "number": "1386765923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5712 IROQUOIS AVE",
            "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": "3120 PEACH ST",
            "address_2": "MCCORMICK HOUSE",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165082734",
            "telephone_number": "814-459-2212",
            "fax_number": "814-874-3492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBORCREEK YOUTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2020-08-22",
        "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": "433390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001410380 0016",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.