Provider Demographics
NPI:1760084115
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:MR
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:740-382-4884
Practice Address - Street 1:200 TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-9238
Practice Address - Country:US
Practice Address - Phone:740-376-0535
Practice Address - Fax:740-376-0153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED CHURCH HOMES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-11
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
OH2224ROtherRESIDENTIAL CARE LICENSE
OH0144843Medicaid