Basic Information
| Provider Information | |||||||||
| NPI: | 1124371422 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIAKON LUTHERAN SOCIAL MINISTRIES DBA FAMILY LIFE SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 960 CENTURY DR | ||||||||
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| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170554374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177950330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 571 MOUNTAIN RD | ||||||||
| Address2: | |||||||||
| City: | BOILING SPRINGS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170079520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177950330 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2012 | ||||||||
| LastUpdateDate: | 10/24/2012 | ||||||||
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| AuthorizedOfficialLastName: | BARGER | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VP AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 7177950395 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 217056 | PA | Y | Agencies | Community/Behavioral Health |
No ID Information.