Provider Demographics
NPI:1225142755
Name:MENNONITE BRETHREN HOMES, INC
Entity Type:Organization
Organization Name:MENNONITE BRETHREN HOMES, INC
Other - Org Name:PALM VILLAGE RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:REIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-638-6933
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-1028
Mailing Address - Country:US
Mailing Address - Phone:559-638-6933
Mailing Address - Fax:559-638-8463
Practice Address - Street 1:703 W HERBERT AVE
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-3941
Practice Address - Country:US
Practice Address - Phone:559-638-6933
Practice Address - Fax:559-638-8463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100404809310400000X
CA040000136314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05965FMedicaid
CA0676230001Medicare NSC
CAZZR05965FMedicaid