Provider Demographics
NPI:1497746713
Name:UNITED CHURCH OF CHRIST HOMES
Entity Type:Organization
Organization Name:UNITED CHURCH OF CHRIST HOMES
Other - Org Name:THE LEBANON VALLEY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR CHIEF EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORVATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-303-1502
Mailing Address - Street 1:550 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-1511
Mailing Address - Country:US
Mailing Address - Phone:717-867-4467
Mailing Address - Fax:717-867-7060
Practice Address - Street 1:550 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003-1511
Practice Address - Country:US
Practice Address - Phone:717-867-4467
Practice Address - Fax:717-867-7060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED CHURCH OF CHRIST HOMES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-04
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA730602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007555290004Medicaid
PA395832Medicare ID - Type Unspecified