Provider Demographics
NPI:1295755189
Name:UNITED CHURCH HOMES MANAGEMENT
Entity type:Organization
Organization Name:UNITED CHURCH HOMES MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-382-4885
Mailing Address - Street 1:1313 W DOROTHY LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1309
Mailing Address - Country:US
Mailing Address - Phone:937-293-1313
Mailing Address - Fax:
Practice Address - Street 1:170 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-1806
Practice Address - Country:US
Practice Address - Phone:937-293-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH51-022729332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0007338431OtherATHENA
OH000000155149OtherANTHEM
OH0854320Medicaid
OH0364690002Medicare ID - Type UnspecifiedMCR PROVIDER NUMBER