Provider Demographics
NPI:1558766980
Name:DIAKON FAMILY LIFE SERVICES
Entity Type:Organization
Organization Name:DIAKON FAMILY LIFE SERVICES
Other - Org Name:DIAKON LUTHERAN SOCIAL MINISTRIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CASE MANAGER 2
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:REIDER
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:717-409-4334
Mailing Address - Street 1:1022 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-2158
Mailing Address - Country:US
Mailing Address - Phone:717-795-0330
Mailing Address - Fax:717-795-0407
Practice Address - Street 1:960 CENTURY DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4530
Practice Address - Country:US
Practice Address - Phone:717-795-0330
Practice Address - Fax:717-795-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health