Provider Demographics
NPI:1093053910
Name:THE MENNONITE HOME
Entity Type:Organization
Organization Name:THE MENNONITE HOME
Other - Org Name:MENNONITE HOME COMMUNITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-393-1301
Mailing Address - Street 1:1520 HARRISBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2632
Mailing Address - Country:US
Mailing Address - Phone:717-393-1301
Mailing Address - Fax:717-509-2823
Practice Address - Street 1:2001 HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2641
Practice Address - Country:US
Practice Address - Phone:717-393-1301
Practice Address - Fax:717-393-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy