Provider Demographics
NPI:1871028449
Name:DIAKONIA
Entity type:Organization
Organization Name:DIAKONIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:WARBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-359-9550
Mailing Address - Street 1:1812 HEWITT AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-5823
Mailing Address - Country:US
Mailing Address - Phone:425-512-9271
Mailing Address - Fax:425-645-2796
Practice Address - Street 1:1812 HEWITT AVE STE 207
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-5823
Practice Address - Country:US
Practice Address - Phone:425-512-9271
Practice Address - Fax:425-645-2796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60618919253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care