MEDICARE: DIAKON LUTHERAN SOCIAL MINISTRIES DBA FAMILY LIFE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	217056	PA

General Provider Information

NPI Number	:	1124371422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAKON LUTHERAN SOCIAL MINISTRIES DBA FAMILY LIFE SERVICES

Provider Business Mailing Address
First Line	:	960 CENTURY DR
Second Line	:
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4374
Country	:	US
Telephone Number	:	717-795-0330
Fax Number	:

Provider Business Practice Location Address
First Line	:	571 MOUNTAIN RD
Second Line	:
City	:	BOILING SPRINGS
State	:	PA
Zip	:	17007-9520
Country	:	US
Telephone Number	:	717-795-0330
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE VP AND CFO
Name	:	RICHARD M BARGER
Credential	:	CPA
Telephone Number	:	717-795-0395

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	10/24/2012

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