1942239546 NPI number — DIAKON LUTHERAN SOCIAL MINISTRIES

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 1942239546 NPI number — DIAKON LUTHERAN SOCIAL MINISTRIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAKON LUTHERAN SOCIAL 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:
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:
1942239546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2007
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:
1725 SCHOOLHOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNCANNON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17020-9582
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:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROUSSEAU
Authorized Official First Name:
RITA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR COS
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)

  • Identifier: 02319100 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007777400058 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 301029 . This is a "VALUEOPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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