NPIMap

Organization Active NPI

Harborcreek Youth Services

  • Community/Behavioral Health Agency
  • Harborcreek, PA
National Provider Identifier
1740287622
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
HARBORCREEK YOUTH SERVICES
Practice address
5712 Iroquois Ave
MST Ibhs Program
Harborcreek, PA 16421-1009
Phone
(814) 899-7664
Fax
(814) 899-3075
NPI assigned
Jul 7, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2025

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 001410380 0014 PA
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

5712 Iroquois Ave
MST Ibhs Program
Harborcreek, PA 16421-1009

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
001410380 0014MedicaidPA
0014103800051MedicaidPA

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": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747267200000",
    "number": "1740287622",
    "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": "5712 IROQUOIS AVE",
            "address_2": "MST IBHS PROGRAM",
            "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": "2005-07-07",
        "last_updated": "2025-05-15",
        "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": "MSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "001410380 0014",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001410380 0014",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0014103800051",
            "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 May 15, 2025; 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.