Provider Demographics
NPI:1649237926
Name:DIAKON LUTHERAN SOCIAL MINISTRIES
Entity Type:Organization
Organization Name:DIAKON LUTHERAN SOCIAL MINISTRIES
Other - Org Name:MOUNTAIN GLADE ADULT DAY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, RESIDENT FINANCIAL SERV
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-795-0309
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:717-795-0309
Mailing Address - Fax:717-795-0453
Practice Address - Street 1:375 PYTHIAN AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-5111
Practice Address - Country:US
Practice Address - Phone:301-334-0585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15908251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD600003700Medicaid