Provider Demographics
NPI:1528041647
Name:UNITED CHURCH HOMES, INC.
Entity Type:Organization
Organization Name:UNITED CHURCH HOMES, INC.
Other - Org Name:PATRIOT RIDGE COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP 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 1:789 STONEYBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-6021
Mailing Address - Country:US
Mailing Address - Phone:937-878-0262
Mailing Address - Fax:
Practice Address - Street 1:789 STONEYBROOK TRL
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-6021
Practice Address - Country:US
Practice Address - Phone:937-878-0262
Practice Address - Fax:
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:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5967314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2203814Medicaid
OH2203814Medicaid