MEDICARE: MH HUBER HEIGHTS OPERATING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1538722319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MH HUBER HEIGHTS OPERATING, LLC

Provider Business Mailing Address
First Line	:	6200 BELLEFONTAINE RD
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-4009
Country	:	US
Telephone Number	:	937-236-1800
Fax Number	:	937-237-5076

Provider Business Practice Location Address
First Line	:	6200 BELLEFONTAINE RD
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-4009
Country	:	US
Telephone Number	:	937-236-1800
Fax Number	:	937-237-5076

Authorized Official
Title or Position	:	REIMBURSEMENT ANALYST
Name	:	MR. HENRY J VAUGHN
Credential	:
Telephone Number	:	240-595-6025

Provider Enumeration Date	:	04/17/2019
Last Update Date	:	04/17/2019

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