Provider Demographics
NPI:1558958769
Name:UNITED CHURCH HOMES INC
Entity Type:Organization
Organization Name:UNITED CHURCH HOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCIAL SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-223-2022
Mailing Address - Street 1:PO BOX 1806
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43301-1806
Mailing Address - Country:US
Mailing Address - Phone:740-382-4885
Mailing Address - Fax:
Practice Address - Street 1:3218 INDIAN RIPPLE RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3637
Practice Address - Country:US
Practice Address - Phone:937-426-8481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1577RMedicaid