Provider Demographics
NPI:1891964193
Name:DIVERSIFIED FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:DIVERSIFIED FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEMENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-346-2123
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:5454 E STATE STREET
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-0027
Mailing Address - Country:US
Mailing Address - Phone:724-346-2123
Mailing Address - Fax:724-346-0366
Practice Address - Street 1:5454 E STATE ST
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-9441
Practice Address - Country:US
Practice Address - Phone:724-346-2123
Practice Address - Fax:724-346-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA422350251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health