Provider Demographics
NPI:1023658895
Name:ICHS CORPORATIOIN
Entity type:Organization
Organization Name:ICHS CORPORATIOIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:POEPPERLING
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:570-703-0755
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:PA
Mailing Address - Zip Code:18471-0073
Mailing Address - Country:US
Mailing Address - Phone:570-575-5443
Mailing Address - Fax:570-280-7931
Practice Address - Street 1:73 MONTAGE MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507
Practice Address - Country:US
Practice Address - Phone:570-703-0755
Practice Address - Fax:570-280-7931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT019002OtherLICENSE
PAAK000628OtherLICENSE