1689084741 NPI number — DIAKON CHILD, FAMILY & COMMUNITY

Table of content: (NPI 1689084741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689084741 NPI number — DIAKON CHILD, FAMILY & COMMUNITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAKON CHILD, FAMILY & COMMUNITY
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:
DIAKON FAMILY LIFE SERVICES
Provider Other Organization Name Type Code:
3
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:
1689084741
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
435 W 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17701-6001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-322-7873
Provider Business Mailing Address Fax Number:
570-322-8026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
571 MOUNTAIN RD # 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOILING SPRINGS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17007-9520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-795-0330
Provider Business Practice Location Address Fax Number:
717-795-0407
Provider Enumeration Date:
04/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ROUSSEAU
Authorized Official First Name:
RITA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
717-795-0368

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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