Provider Demographics
NPI:1407838055
Name:HEALTH POCONOS, INC
Entity Type:Organization
Organization Name:HEALTH POCONOS, INC
Other - Org Name:RIVERSIDE REHABILITATION CENTER II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-908-8119
Mailing Address - Street 1:100 COMMUNITY DR
Mailing Address - Street 2:207
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-8985
Mailing Address - Country:US
Mailing Address - Phone:570-839-9975
Mailing Address - Fax:570-839-9274
Practice Address - Street 1:100 COMMUNITY DR
Practice Address - Street 2:105
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-8985
Practice Address - Country:US
Practice Address - Phone:570-839-9975
Practice Address - Fax:570-839-9274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0400X
PA394532261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE56832OtherAMERIHEALTH
PA0510083000OtherIBC
PA81386OtherTHREE RIVERS
PA2451453209OtherGEISINGER
PA50004997OtherCAPITAL BLUE CROSS
PA543451OtherAETNA
PA2Y4263OtherHEALTHNET
PA001467795Medicaid
PARI556832OtherBLUE SHIELD #
PA81386OtherTHREE RIVERS
PA50004997OtherCAPITAL BLUE CROSS
PA001467795Medicaid