Healthcare Provider Details

I. General information

NPI: 1790852879
Provider Name (Legal Business Name): MILLER HOLDINGS MAG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 WOODBINE AVE
CINCINNATI OH
45216-1313
US

IV. Provider business mailing address

2460 ELM RD NE SUITE 600
WARREN OH
44483-2900
US

V. Phone/Fax

Practice location:
  • Phone: 513-761-4943
  • Fax: 513-821-9318
Mailing address:
  • Phone: 330-307-6816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: KURT MILLER
Title or Position: PRESIDENT
Credential:
Phone: 330-307-6816