Healthcare Provider Details

I. General information

NPI: 1427393685
Provider Name (Legal Business Name): MENNONITE MEMORIAL HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WILLOW RIDGE DRIVE
BLUFFTON OH
45817-8552
US

IV. Provider business mailing address

410 W ELM ST
BLUFFTON OH
45817-1122
US

V. Phone/Fax

Practice location:
  • Phone: 419-358-1015
  • Fax: 419-358-0397
Mailing address:
  • Phone: 419-358-1015
  • Fax: 419-358-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. LAURA B. VOTH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 419-358-1015