Organization
HARBORCREEK YOUTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN D. PETULLA MSW (CHIEF EXECUTIVE OFFICER)
(814) 899-7664
Entity
Organization
Contact information
Practice address
5712 IROQUOIS AVE, MST IBHS PROGRAM, HARBORCREEK, PA 16421-1009
(814) 899-7664
(814) 899-3075
Mailing address
5712 IROQUOIS AVE, HARBORCREEK, PA 16421-1009
(814) 899-7664
(814) 899-3075
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
001410380 0014
PA
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001410380 0014
—
PA
05
—
0014103800051
—
PA
Enumeration date
07/07/2005
Last updated
05/15/2025
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