Provider Demographics
NPI:1164876751
Name:DIAKON CHILD FAMILY & COMMUNITY MINISTRIES
Entity Type:Organization
Organization Name:DIAKON CHILD FAMILY & COMMUNITY MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:EVELYN
Authorized Official - Last Name:VANDERGAST
Authorized Official - Suffix:
Authorized Official - Credentials:JD,LCSW,FACH
Authorized Official - Phone:610-209-8280
Mailing Address - Street 1:798 HAUSMAN RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9108
Mailing Address - Country:US
Mailing Address - Phone:610-209-8280
Mailing Address - Fax:
Practice Address - Street 1:1 S HOME AVE
Practice Address - Street 2:
Practice Address - City:TOPTON
Practice Address - State:PA
Practice Address - Zip Code:19562-1317
Practice Address - Country:US
Practice Address - Phone:610-682-1504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA141050253J00000X
PA331500253J00000X
PA331540253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency