NPIMap

Organization Active NPI

Diakon Child,Family&Community Ministries

  • Adolescent and Children Mental Health Clinic/Center
  • Williamsport, PA
National Provider Identifier
1174021836
Registry record updated Jan 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
DIAKON CHILD,FAMILY&COMMUNITY MINISTRIES
Practice address
1801 Loyalsock Dr
Williamsport, PA 17701-2829
Phone
(570) 322-7873
Fax
(570) 322-8026
NPI assigned
Jan 29, 2018
Organization subpart
Yes
Parent organization
DIAKON LUTHERAN SOCIAL MINISTRIESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 29, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Deborah P White
Title
Director of Administrative Ops
Phone
(570) 322-7878

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

1801 Loyalsock Dr
Williamsport, PA 17701-2829

Mailing address

435 W 4TH St
Williamsport, PA 17701-6001
Phone (570) 322-7873

Other identifiers 1

IdentifierTypeStateIssuer
102920256-0001MedicaidPA

National Provider Directory

National Provider Directory
Tax ID family
Diakon Child Family Community Ministries26 organizations share this tax ID, including this one
Part of
Buffalo Vly Nursing HM

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517184000000",
    "number": "1174021836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 W 4TH ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177016001",
            "telephone_number": "570-322-7873",
            "fax_number": "570-322-8026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 LOYALSOCK DR",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177012829",
            "telephone_number": "570-322-7873",
            "fax_number": "570-322-8026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAKON CHILD,FAMILY&COMMUNITY MINISTRIES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIAKON LUTHERAN SOCIAL MINISTRIES",
        "enumeration_date": "2018-01-29",
        "last_updated": "2018-01-29",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "DIRECTOR OF ADMINISTRATIVE OPS",
        "authorized_official_telephone_number": "570-322-7878"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102920256-0001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsport, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.