Provider Demographics
NPI:1821241928
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 FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:D
Authorized Official - Last Name:REBER
Authorized Official - Suffix:
Authorized Official - Credentials:
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:19464-6439
Mailing Address - Country:US
Mailing Address - Phone:484-941-0500
Mailing Address - Fax:484-941-0515
Practice Address - Street 1:35 EVANSBURG RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426
Practice Address - Country:US
Practice Address - Phone:484-854-9833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREATIVE HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-03
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100751163Medicaid