Provider Demographics
NPI:1124371422
Name:DIAKON LUTHERAN SOCIAL MINISTRIES DBA FAMILY LIFE SERVICES
Entity Type:Organization
Organization Name:DIAKON LUTHERAN SOCIAL MINISTRIES DBA FAMILY LIFE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARGER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:717-795-0395
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:717-795-0330
Mailing Address - Fax:
Practice Address - Street 1:571 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17007-9520
Practice Address - Country:US
Practice Address - Phone:717-795-0330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA217056251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA655827Medicare PIN