Provider Demographics
NPI:1689022394
Name:DIAKON CHILD, FAMILY & COMMUNITY MINISTRIES
Entity Type:Organization
Organization Name:DIAKON CHILD, FAMILY & COMMUNITY MINISTRIES
Other - Org Name:DIAKON FAMILY LIFE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CFO/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:HABECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-795-0384
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:717-795-0384
Mailing Address - Fax:717-795-0353
Practice Address - Street 1:520 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6038
Practice Address - Country:US
Practice Address - Phone:717-795-0384
Practice Address - Fax:717-795-0353
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAKON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA331610251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health