Healthcare Provider Details

I. General information

NPI: 1023658895
Provider Name (Legal Business Name): ICHS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 MONTAGE MOUNTAIN ROAD
MOOSIC PA
18507
US

IV. Provider business mailing address

PO BOX 73
WAVERLY PA
18471-0073
US

V. Phone/Fax

Practice location:
  • Phone: 570-703-0755
  • Fax: 570-280-7931
Mailing address:
  • Phone: 570-575-5443
  • Fax: 570-280-7931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPT019002
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerLICENSE
# 2
IdentifierAK000628
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerLICENSE

VIII. Authorized Official

Name: DR. JAMES POEPPERLING
Title or Position: PRESIDENT
Credential: DPT
Phone: 570-703-0755