Healthcare Provider Details

I. General information

NPI: 1043391832
Provider Name (Legal Business Name): INTERIM HEALTH CARE SRVCS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 3RD ST FIRST FLOOR
BLAKELY PA
18447-1017
US

IV. Provider business mailing address

200 3RD ST FIRST FLOOR
BLAKELY PA
18447-1017
US

V. Phone/Fax

Practice location:
  • Phone: 570-883-9773
  • Fax: 570-883-9779
Mailing address:
  • Phone: 570-883-9773
  • Fax: 570-883-9779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number745705
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MARK ZESHONSKI
Title or Position: ASST. ADMINISTRATOR
Credential:
Phone: 570-489-6781