Provider Demographics
NPI:1427393685
Name:MENNONITE MEMORIAL HOME
Entity Type:Organization
Organization Name:MENNONITE MEMORIAL HOME
Other - Org Name:WILLOW RIDGE OF MENNONITE HOME COMMUNITIES OF OHIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:VOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-358-1015
Mailing Address - Street 1:410 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:OH
Mailing Address - Zip Code:45817-1122
Mailing Address - Country:US
Mailing Address - Phone:419-358-1015
Mailing Address - Fax:419-358-1919
Practice Address - Street 1:101 WILLOW RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-8552
Practice Address - Country:US
Practice Address - Phone:419-358-1015
Practice Address - Fax:419-358-0397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENNONITE MEMORIAL HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-29
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility