Healthcare Provider Details

I. General information

NPI: 1972586980
Provider Name (Legal Business Name): UNITED CHURCH HOMES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 STRAUSSER ST NW
CANAL FULTON OH
44614-9479
US

IV. Provider business mailing address

12200 STRAUSSER ST NW
CANAL FULTON OH
44614-9479
US

V. Phone/Fax

Practice location:
  • Phone: 330-854-4177
  • Fax:
Mailing address:
  • Phone: 330-854-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1180N
License Number StateOH

VIII. Authorized Official

Name: MR. ROB WEISBRODT
Title or Position: VP IT SERVICES
Credential:
Phone: 740-382-4885