Provider Demographics
NPI:1437670007
Name:POCONO SUPPORT COORDINATION LLC
Entity Type:Organization
Organization Name:POCONO SUPPORT COORDINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOPEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-534-0489
Mailing Address - Street 1:102 LAMP POST LN
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-9866
Mailing Address - Country:US
Mailing Address - Phone:570-534-0489
Mailing Address - Fax:
Practice Address - Street 1:102 LAMP POST LN
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-9866
Practice Address - Country:US
Practice Address - Phone:570-534-0489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-04
Last Update Date:2017-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management