1265842413 NPI number — DIAKON CHILD, FAMILY & COMMUNITY MINISTRIES

Table of content: (NPI 1265842413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265842413 NPI number — DIAKON CHILD, FAMILY & COMMUNITY MINISTRIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAKON CHILD, FAMILY & COMMUNITY MINISTRIES
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:
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:
1265842413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2018
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:
1800 W MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17837-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-524-9477
Provider Business Practice Location Address Fax Number:
570-524-9492
Provider Enumeration Date:
04/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
P
Authorized Official Title or Position:
DIRECTOR OF ADMINISTRATIVE OPS
Authorized Official Telephone Number:
570-322-7878

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)

  • Identifier: 02319100 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 301029 . This is a "VALUEOPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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