Provider Demographics
NPI:1093272585
Name:CREATIVE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:CREATIVE HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:P
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:TRENTACOSTE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MBA
Authorized Official - Phone:484-941-0500
Mailing Address - Street 1:11 ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-6421
Mailing Address - Country:US
Mailing Address - Phone:484-941-0515
Mailing Address - Fax:484-941-0515
Practice Address - Street 1:180 W GERMANTOWN PIKE STE 1
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1378
Practice Address - Country:US
Practice Address - Phone:484-687-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREATIVE HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA137220Medicaid