1114985975 NPI number — DIAKON HOME CARE SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114985975 NPI number — DIAKON HOME CARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAKON HOME CARE SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114985975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
960 CENTURY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17055-4374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-795-0309
Provider Business Mailing Address Fax Number:
717-795-0453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 N CHURCH ST
Provider Second Line Business Practice Location Address:
SUITE 403, BUILDING B
Provider Business Practice Location Address City Name:
HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18202-1453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-453-5200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCHUGH
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DIRECTOR, RESIDENT FINANCIAL SERV
Authorized Official Telephone Number:
717-795-0309

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  02340501 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1012097480001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".