1174581953 NPI number — DIAKON LUTHERAN SOCIAL MINSITRIES

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 1174581953 NPI number — DIAKON LUTHERAN SOCIAL MINSITRIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAKON LUTHERAN SOCIAL MINSITRIES
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:
ADULT DAY SERVICES AT RAVENWOOD LUTHERAN VILLAGE
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:
1174581953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2008
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:
1109 LUTHER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740-7407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-790-1000
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 SERVIC
Authorized Official Telephone Number:
717-795-0309

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  13179 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 043833200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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