Provider Demographics
NPI:1023163854
Name:INDIAN CREEK FOUNDATION
Entity type:Organization
Organization Name:INDIAN CREEK FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOESZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-203-1500
Mailing Address - Street 1:420 COWPATH RD
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-2036
Mailing Address - Country:US
Mailing Address - Phone:267-203-1500
Mailing Address - Fax:267-203-1510
Practice Address - Street 1:420 COWPATH RD
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-2036
Practice Address - Country:US
Practice Address - Phone:267-203-1500
Practice Address - Fax:267-203-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA535030315P00000X
PA509170315P00000X
PA509140315P00000X
PA509120315P00000X
PA509100315P00000X
PA535040315P00000X
163W00000X, 164W00000X
PA105080251S00000X
PA188770251S00000X
PA138590251S00000X
PA1476426251S00000X
PA505630315P00000X
PA505620315P00000X
PA105070251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual DisabilitiesGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100000818Medicaid
PA23122000OtherMAGELLAN BEHAVIORAL HEALT
PA23122000OtherMAGELLAN BEHAVIORAL HEALT