Provider Demographics
NPI:1467821207
Name:DIAKON CHILD, FAMILY AND COMMUNITY MINISTRIES
Entity Type:Organization
Organization Name:DIAKON CHILD, FAMILY AND COMMUNITY MINISTRIES
Other - Org Name:DIAKON FAMILY LIFE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT/COO/FCO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:HABECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-682-1262
Mailing Address - Street 1:435 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6001
Mailing Address - Country:US
Mailing Address - Phone:570-322-7873
Mailing Address - Fax:570-322-8026
Practice Address - Street 1:241 BROAD ST
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-2283
Practice Address - Country:US
Practice Address - Phone:570-433-7060
Practice Address - Fax:570-567-7184
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAKON LUTHERAN SOCIAL MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA331600251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health