Provider Demographics
NPI:1043391832
Name:INTERIM HEALTH CARE SRVCS, INC.
Entity Type:Organization
Organization Name:INTERIM HEALTH CARE SRVCS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZESHONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-489-6781
Mailing Address - Street 1:200 3RD ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:BLAKELY
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1017
Mailing Address - Country:US
Mailing Address - Phone:570-883-9773
Mailing Address - Fax:570-883-9779
Practice Address - Street 1:200 3RD ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BLAKELY
Practice Address - State:PA
Practice Address - Zip Code:18447-1017
Practice Address - Country:US
Practice Address - Phone:570-883-9773
Practice Address - Fax:570-883-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163W00000X, 164W00000X
PA745705251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000044970007Medicaid
PA397457OtherBLUE CROSS OF NEPA
PA1000044970007Medicaid