Provider Demographics
NPI:1033957857
Name:MENNONITE MEMORIAL HOME COMMUNITIES OF OHIO
Entity type:Organization
Organization Name:MENNONITE MEMORIAL HOME COMMUNITIES OF OHIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKLES
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:419-358-1015
Mailing Address - Street 1:410 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:OH
Mailing Address - Zip Code:45817-1122
Mailing Address - Country:US
Mailing Address - Phone:419-358-1015
Mailing Address - Fax:419-358-1919
Practice Address - Street 1:410 W ELM ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-1122
Practice Address - Country:US
Practice Address - Phone:419-358-1015
Practice Address - Fax:419-358-1919
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENNONITE MEMORIAL HOME COMMUNITIES OF OHIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-16
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility