Healthcare Provider Details

I. General information

NPI: 1588647119
Provider Name (Legal Business Name): UNITED CHURCH HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 E HANNA AVE
INDIANAPOLIS IN
46237-1230
US

IV. Provider business mailing address

3525 E HANNA AVE
INDIANAPOLIS IN
46237-1230
US

V. Phone/Fax

Practice location:
  • Phone: 317-788-4261
  • Fax:
Mailing address:
  • Phone: 317-788-4261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateIN

VIII. Authorized Official

Name: MR. ROB WEISBRODT
Title or Position: VP IT SERVICES
Credential:
Phone: 740-382-4885