Provider Demographics
NPI:1144203449
Name:UNITED CHURCH HOMES, INC
Entity Type:Organization
Organization Name:UNITED CHURCH HOMES, INC
Other - Org Name:FOUR WINDS COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. IT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISBRODT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-382-4885
Mailing Address - Street 1:215 SETH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-9405
Mailing Address - Country:US
Mailing Address - Phone:740-286-7551
Mailing Address - Fax:740-286-7191
Practice Address - Street 1:215 SETH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9405
Practice Address - Country:US
Practice Address - Phone:740-286-7551
Practice Address - Fax:740-286-7191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED CHURCH HOMES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-22
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5810314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2158418Medicaid
OH2530000001Medicare NSC
OH2158418Medicaid