Provider Demographics
NPI:1033176557
Name:DIAKON LUTHERAN SOCIAL MINISTRIES
Entity Type:Organization
Organization Name:DIAKON LUTHERAN SOCIAL MINISTRIES
Other - Org Name:BUFFALO VALLEY LUTHERAN VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP, FINANCIAL PLANNING & OPE
Authorized Official - Prefix:
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-795-0309
Mailing Address - Street 1:1022 NORTH UNION STREET
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-2158
Mailing Address - Country:US
Mailing Address - Phone:717-795-0386
Mailing Address - Fax:717-795-0353
Practice Address - Street 1:189 EAST TRESSLER BOULEVARD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-8808
Practice Address - Country:US
Practice Address - Phone:570-524-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAKON LUTHERAN SOCIAL MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-27
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA023602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007777400014Medicaid
PA395261Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER