Healthcare Provider Details

I. General information

NPI: 1255873477
Provider Name (Legal Business Name): UNITED CHURCH HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 LEONARD ST NE
GRAND RAPIDS MI
49505-5837
US

IV. Provider business mailing address

2000 LEONARD ST NE
GRAND RAPIDS MI
49505-5837
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOHN K RENNER
Title or Position: SENIOR VICE PRESIDENT/CFO
Credential:
Phone: 740-382-4885