Provider Demographics
NPI:1548251879
Name:UNITED CHURCH OF CHRIST HOMES
Entity type:Organization
Organization Name:UNITED CHURCH OF CHRIST HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR CHIEF EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORVATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-303-1502
Mailing Address - Street 1:99 BETHANY RD
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-8637
Mailing Address - Country:US
Mailing Address - Phone:717-738-4940
Mailing Address - Fax:717-738-7478
Practice Address - Street 1:99 BETHANY RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-8637
Practice Address - Country:US
Practice Address - Phone:717-738-4940
Practice Address - Fax:717-738-7478
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED CHURCH OF CHRIST HOMES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-04
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA053502314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007555290001Medicaid
PA395857Medicare ID - Type Unspecified