Provider Demographics
NPI:1093125163
Name:DIAKON CHILD, FAMILY & COMMUNITY
Entity Type:Organization
Organization Name:DIAKON CHILD, FAMILY & COMMUNITY
Other - Org Name:MANATAWNY ADULT DAY CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, RESIDENT FINANCIAL SERVIC
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-795-0309
Mailing Address - Street 1:960 CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4374
Mailing Address - Country:US
Mailing Address - Phone:717-795-0309
Mailing Address - Fax:717-795-0453
Practice Address - Street 1:30 OLD SCHUYLKILL RD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-7971
Practice Address - Country:US
Practice Address - Phone:610-705-3749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007358670003Medicaid