Healthcare Provider Details

I. General information

NPI: 1073100483
Provider Name (Legal Business Name): UNITED CHURCH HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 LEONARD ST NE
GRAND RAPIDS MI
49505-5837
US

IV. Provider business mailing address

PO BOX 1806
MARION OH
43301-1806
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-1133
  • Fax:
Mailing address:
  • Phone: 740-382-4885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: RICHARD D DIBLE
Title or Position: VICE PRESIDENT OF FINANCIAL SERVICE
Credential:
Phone: 740-223-2022