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General NPI Number Information
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NPI Number | 1033148630
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Entity Type | Organization
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Legal Business Name | DIAKON LUTHERAN SOCIAL MINISTRIES
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 1100 MONTOUR RD
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City | LOYSVILLE
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State | PA
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Zip | 17047-9200
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Country | US
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Telephone | 717-795-0330
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Fax | 717-795-0407
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Provider Business Mailing Address
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Address Line | 435 W 4TH ST
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-6001
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Country | US
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Telephone | 570-322-7873
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Fax | 570-322-8026
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR COS
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Name | RITA A. ROUSSEAU
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Credential |
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Telephone | 717-795-0368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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