Provider Demographics
NPI:1124194121
Name:CREATIVE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CREATIVE HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
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:PHYD, 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:484-941-0500
Mailing Address - Fax:484-941-0515
Practice Address - Street 1:929 WILLOW ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-1811
Practice Address - Country:US
Practice Address - Phone:610-326-7734
Practice Address - Fax:610-326-4762
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREATIVE HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-28
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1015302084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100751163Medicaid