MEDICARE: MILLER HOLDINGS ELYRIA, INC.

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	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1164910634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLER HOLDINGS ELYRIA, INC.

Provider Business Mailing Address
First Line	:	2460 ELM RD NE STE 600
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-2949
Country	:	US
Telephone Number	:	330-307-6816
Fax Number	:

Provider Business Practice Location Address
First Line	:	1251 EAST AVE
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-7674
Country	:	US
Telephone Number	:	440-322-0726
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KURT MILLER
Credential	:
Telephone Number	:	330-307-6816

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	05/03/2018

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