Provider Demographics
NPI:1417110222
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:PHY D 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 1:11 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-6439
Practice Address - Country:US
Practice Address - Phone:484-941-0500
Practice Address - Fax:484-941-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100751163Medicaid
PA100751163Medicaid