Provider Demographics
NPI:1295342079
Name:POUCHER, JADE M
Entity type:Individual
Prefix:MS
First Name:JADE
Middle Name:M
Last Name:POUCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-1002
Mailing Address - Country:US
Mailing Address - Phone:567-344-2161
Mailing Address - Fax:
Practice Address - Street 1:715 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-1002
Practice Address - Country:US
Practice Address - Phone:567-344-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health
No347C00000XTransportation ServicesPrivate Vehicle