Healthcare Provider Details

I. General information

NPI: 1619007879
Provider Name (Legal Business Name): UNITED CHURCH HOMES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MISSION DR
UPPER SANDUSKY OH
43351-1067
US

IV. Provider business mailing address

PO BOX 1806 170 E. CENTER ST
MARION OH
43301-1806
US

V. Phone/Fax

Practice location:
  • Phone: 740-382-4885
  • Fax: 740-382-4884
Mailing address:
  • Phone: 740-382-4885
  • Fax: 740-382-4884

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: MR. ROB L WEISBRODT
Title or Position: VICE PRESIDENT, IT SERVICE
Credential:
Phone: 740-382-4885