Provider Demographics
NPI:1629488861
Name:DIAKON CHILD FAMILY AND COMMUNITY MINISTRIES
Entity type:Organization
Organization Name:DIAKON CHILD FAMILY AND COMMUNITY MINISTRIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERGAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-209-8280
Mailing Address - Street 1:5000 RITTER ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-6922
Mailing Address - Country:US
Mailing Address - Phone:717-795-0330
Mailing Address - Fax:717-795-0407
Practice Address - Street 1:5000 RITTER ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-6922
Practice Address - Country:US
Practice Address - Phone:717-795-0330
Practice Address - Fax:717-795-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA307850101YM0800X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029202560005Medicaid