Provider Demographics
NPI:1114985975
Name:DIAKON HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:DIAKON HOME CARE SERVICES, LLC
Other - Org Name:DIAKON HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, RESIDENT FINANCIAL SERV
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 1:1201 N CHURCH ST
Practice Address - Street 2:SUITE 403, BUILDING B
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-1453
Practice Address - Country:US
Practice Address - Phone:570-453-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02340501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012097480001Medicaid
PA398007Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER