# DIAKON LUTHERAN SENIOR LIVING-MARYLAND RAVENWOOD CAMPUS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ravenwood Lutheran Village Outpatient Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831348309
- **Authorized official:** SCOTT SOWERS (REIMBURSEMENT MANAGER)
- **Authorized official phone:** (717) 795-0377

## Contact information

- **Practice address:** 19800 TRANQUILITY CIR, HAGERSTOWN, MD 21742-4042
- **Practice address phone:** (301) 790-1000
- **Mailing address:** 960 CENTURY DR, MECHANICSBURG, PA 17055-4374
- **Mailing address phone:** (717) 795-0388

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 21-010 | MD | Yes |

## Other

- **Enumeration date:** 09/09/2008
- **Last updated:** 01/17/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 217547900 | — | MD |