Organization
DIAKON CHILD FAMILY AND COMMUNITY MINISTRIES
Active
Parent organization
DIAKON LUTHERAN SOCIAL MINISTRIES
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIAKON LUTHERAN SOCIAL MINISTRIES
Authorized official
LAUREL SPENCER (CLINICAL DIRECTOR)
(570) 322-7873
Entity
Organization
Contact information
Practice address
2990 W 4TH ST, WILLIAMSPORT, PA 17701-4197
(570) 322-7873
Mailing address
435 W 4TH ST, WILLIAMSPORT, PA 17701-6001
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
331600
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1029202560001
—
PA
01
—
379904
MEDICARE PTAN
PA
Enumeration date
10/16/2015
Last updated
10/16/2015
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