Provider Demographics
NPI:1013363134
Name:DIAKON LUTHERAN SOCIAL MINISTRIES
Entity Type:Organization
Organization Name:DIAKON LUTHERAN SOCIAL MINISTRIES
Other - Org Name:ITS FAMILY LIFE SERVICES OUT PATIENT MENTAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VP/COO/CFO
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 1:2135 N 6TH ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-2404
Practice Address - Country:US
Practice Address - Phone:717-795-0368
Practice Address - Fax:717-795-0353
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAKON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-07
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health