Provider Demographics
NPI:1750467510
Name:UNION CHRISTEL MANOR, INC.
Entity Type:Organization
Organization Name:UNION CHRISTEL MANOR, INC.
Other - Org Name:UCM RESIDENTIAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SYDNEY
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-643-3757
Mailing Address - Street 1:400 S MELVIN ELEY AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45390-8611
Mailing Address - Country:US
Mailing Address - Phone:937-968-6265
Mailing Address - Fax:937-968-6883
Practice Address - Street 1:400 S MELVIN ELEY AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:OH
Practice Address - Zip Code:45390-8611
Practice Address - Country:US
Practice Address - Phone:937-968-6265
Practice Address - Fax:937-968-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1707N315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities