1023163854 NPI number — INDIAN CREEK FOUNDATION

Table of content: (NPI 1023163854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023163854 NPI number — INDIAN CREEK FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIAN CREEK FOUNDATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023163854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 COWPATH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUDERTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18964-2036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-203-1500
Provider Business Mailing Address Fax Number:
267-203-1510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 COWPATH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUDERTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18964-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-203-1500
Provider Business Practice Location Address Fax Number:
267-203-1510
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STOESZ
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
267-203-1500

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 105070 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , with the licence number: 105080 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 188770 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 138590 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 1476426 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: 505630 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: 505620 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: 535030 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: 509170 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: 509140 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: 509120 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: 509100 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X , with the licence number: 535040 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100000818 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23122000 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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