Provider Demographics
NPI:1093976870
Name:UNITED CHURCH HOMES, INC.
Entity Type:Organization
Organization Name:UNITED CHURCH HOMES, INC.
Other - Org Name:FAIRHAVEN - LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCIAL SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-223-2022
Mailing Address - Street 1:850 MARSEILLES AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-1648
Mailing Address - Country:US
Mailing Address - Phone:877-205-0018
Mailing Address - Fax:
Practice Address - Street 1:850 MARSEILLES AVE
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-1648
Practice Address - Country:US
Practice Address - Phone:877-205-0018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED CHURCH HOMES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-24
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D0682181291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory