Healthcare Provider Details

I. General information

NPI: 1184233207
Provider Name (Legal Business Name): CREEK HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 WILLIAM FEATHER DRIVE
VOORHEES TOWNSHIP NJ
08043
US

IV. Provider business mailing address

168 CRUM CREEK DRIVE
WOODLYN PA
19094
US

V. Phone/Fax

Practice location:
  • Phone: 215-510-0509
  • Fax:
Mailing address:
  • Phone: 215-510-0509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ONYEMAECHI EMMANUEL OKORO
Title or Position: OWNER
Credential:
Phone: 215-510-0509