Organization
STONEYCREEK RESIDENTIAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY J. NULTON PHD (PRESIDENT)
(814) 262-0025
Entity
Organization
Contact information
Practice address
320 EISENHOWER BLVD, JOHNSTOWN, PA 15905-3603
(814) 262-0025
Mailing address
320 EISENHOWER BLVD, JOHNSTOWN, PA 15905-3603
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
311620
PA
Other
Enumeration date
03/12/2007
Last updated
08/22/2020
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