Provider Demographics
NPI:1518462530
Name:DIAKONIA, INC.
Entity Type:Organization
Organization Name:DIAKONIA, INC.
Other - Org Name:ACHIEVE RESIDENTIAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEAD OF SERVICE/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-570-7823
Mailing Address - Street 1:1264 S LILAC AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-7443
Mailing Address - Country:US
Mailing Address - Phone:951-570-7823
Mailing Address - Fax:888-356-9214
Practice Address - Street 1:1264 S LILAC AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-7443
Practice Address - Country:US
Practice Address - Phone:909-874-6544
Practice Address - Fax:909-873-9563
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAKONIA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children