| Harborcreek Youth Services | |
|
5712 Iroquois Ave Mst Program Harborcreek PA 16421-1009 | |
| (814) 899-7664 | |
| (814) 899-3075 |
| Full Name | Harborcreek Youth Services |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5712 Iroquois Ave, Harborcreek, Pennsylvania |
| Authorized Official Name and Position | John D. Petulla (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8148997664 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Harborcreek Youth Services 5712 Iroquois Avenue Harborcreek PA 16421 Ph: (814) 899-7664 | Harborcreek Youth Services 5712 Iroquois Ave Mst Program Harborcreek PA 16421-1009 Ph: (814) 899-7664 |
| NPI Number | 1740287622 |
|---|---|
| Provider Enumeration Date | 07/07/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740287622 | NPI | - | NPPES |
| 001410380 0014 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 001410380 0014 (Pennsylvania) | Primary |