Healthcare Provider Details

I. General information

NPI: 1831907005
Provider Name (Legal Business Name): MENNONITE MEMORIAL HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W ELM ST
BLUFFTON OH
45817-1122
US

IV. Provider business mailing address

750 CHESTNUT ST
GREENVILLE OH
45331-1312
US

V. Phone/Fax

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

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: JOHN WARNER
Title or Position: DIRECTOR
Credential:
Phone: 937-547-7605