1245282714 NPI number — INTERIM HEALTH CARE SRVCS, INC.

Table of content: (NPI 1245282714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245282714 NPI number — INTERIM HEALTH CARE SRVCS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERIM HEALTH CARE SRVCS, INC.
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:
1245282714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLAKELY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18447-1017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-489-6781
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5925 TILGHMAN ST
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18104-9159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-434-7277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZESHONSKI
Authorized Official First Name:
CARL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-489-6781

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  720205 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1000044970017 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 397202 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1767 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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