Healthcare Provider Details

I. General information

NPI: 1841267259
Provider Name (Legal Business Name): MENNONITE MEMORIAL HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W ELM ST
BLUFFTON OH
45817-1122
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: 419-358-1919
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 Number6145
License Number StateOH

VIII. Authorized Official

Name: MRS. LAURA B. VOTH
Title or Position: CEO
Credential:
Phone: 419-358-1015